Provider Demographics
NPI:1043259807
Name:ROACH, ROBERT G (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:G
Last Name:ROACH
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:14700 FM 2100 RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CROSBY
Mailing Address - State:TX
Mailing Address - Zip Code:77532-9161
Mailing Address - Country:US
Mailing Address - Phone:281-328-2568
Mailing Address - Fax:281-328-2039
Practice Address - Street 1:14700 FM 2100 RD
Practice Address - Street 2:SUITE A
Practice Address - City:CROSBY
Practice Address - State:TX
Practice Address - Zip Code:77532-9161
Practice Address - Country:US
Practice Address - Phone:281-328-2568
Practice Address - Fax:281-328-2039
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2024-04-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXK9887207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX049972003Medicaid
TX8P1990OtherBCBS
TX8P1990OtherBCBS
TX8P1990OtherBCBS
TX680580620OtherTIN