Provider Demographics
NPI:1073577748
Name:SANCHEZ, ROLDON (PA)
Entity Type:Individual
Prefix:
First Name:ROLDON
Middle Name:
Last Name:SANCHEZ
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:1015 S COMMERCE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-5018
Mailing Address - Country:US
Mailing Address - Phone:580-223-4795
Mailing Address - Fax:580-223-5184
Practice Address - Street 1:2002 12TH AVE NW
Practice Address - Street 2:SUITE B
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1206
Practice Address - Country:US
Practice Address - Phone:580-223-4795
Practice Address - Fax:580-223-5184
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2017-02-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OKPA877363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200067040AMedicaid
OK970010036OtherRAILROAD MEDICARE
OKS46361Medicare UPIN