Provider Demographics
NPI:1003802174
Name:ROCHE, STEVE A (MD)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:A
Last Name:ROCHE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12850 HILLCREST RD
Mailing Address - Street 2:SUITE F-206
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-1529
Mailing Address - Country:US
Mailing Address - Phone:972-404-8253
Mailing Address - Fax:972-701-0874
Practice Address - Street 1:12850 HILLCREST RD
Practice Address - Street 2:SUITE F-206
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1529
Practice Address - Country:US
Practice Address - Phone:972-404-8253
Practice Address - Fax:972-701-0874
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG60862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099855101Medicaid
TX099855101Medicaid
TX00QY16Medicare ID - Type Unspecified