MEDICARE: DR. PATRICIA J ROY DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	5101008446	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0156100264	OTHER	MI	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770580045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA J ROY DO

Provider Business Mailing Address
First Line	:	1864 LAKESHORE DR
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49441-1607
Country	:	US
Telephone Number	:	231-755-1628
Fax Number	:	231-755-5279

Provider Business Practice Location Address
First Line	:	1864 LAKESHORE DR
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49441-1607
Country	:	US
Telephone Number	:	231-755-1628
Fax Number	:	231-755-5279

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	02/02/2022

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