MEDICARE: FRITZLAINE C. ROCHE MD

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	208000000X	Pediatrics Physician	2021020661	MO
2	207N00000X	Dermatology Physician	2021020661	MO
3	208000000X	Pediatrics Physician	9410577	KS
4	207N00000X	Dermatology Physician	2024043275	MO

General Provider Information

NPI Number	:	1841876588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRITZLAINE C. ROCHE MD

Provider Business Mailing Address
First Line	:	1 BARNES JEW HOSP PLZ
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1003
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 BARNES JEW HOSP PLZ
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1003
Country	:	US
Telephone Number	:	314-454-8622
Fax Number	:

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

Provider Enumeration Date	:	03/23/2021
Last Update Date	:	03/09/2026

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