MEDICARE: DR. JUSTIN JAMES ROESCH M.D

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	207R00000X	Internal Medicine Physician	D75573	MD
2	207R00000X	Internal Medicine Physician	MD2014-0547	NM
3	207R00000X	Internal Medicine Physician	R71674	AZ
4	207R00000X	Internal Medicine Physician	DR.0063333	CO

General Provider Information

NPI Number	:	1831327840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN JAMES ROESCH M.D

Provider Business Mailing Address
First Line	:	2021 BATTLECREEK DR UNIT A
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-5120
Country	:	US
Telephone Number	:	970-818-5725
Fax Number	:

Provider Business Practice Location Address
First Line	:	2021 BATTLECREEK DR UNIT A
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-5120
Country	:	US
Telephone Number	:	970-818-5725
Fax Number	:

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

Provider Enumeration Date	:	06/29/2009
Last Update Date	:	06/04/2025

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