Provider Demographics
NPI:1003873704
Name:ROQUE, CARLOS M (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:M
Last Name:ROQUE
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:PO BOX 7001
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00694-7001
Mailing Address - Country:US
Mailing Address - Phone:787-858-1580
Mailing Address - Fax:
Practice Address - Street 1:CARR NUM. 2 KM.39.5 HOSPITAL WILMA N VAZQUEZ
Practice Address - Street 2:CALL BOX 7001
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00694-7001
Practice Address - Country:US
Practice Address - Phone:787-858-1580
Practice Address - Fax:787-858-2385
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6709208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC84223Medicare UPIN
PR0098208Medicare ID - Type Unspecified