Provider Demographics
NPI:1073634275
Name:GUY, ROXANNE J (MD)
Entity Type:Individual
Prefix:DR
First Name:ROXANNE
Middle Name:J
Last Name:GUY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E HIBISCUS BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3102
Mailing Address - Country:US
Mailing Address - Phone:321-727-1600
Mailing Address - Fax:321-676-3644
Practice Address - Street 1:111 E HIBISCUS BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3102
Practice Address - Country:US
Practice Address - Phone:321-727-1600
Practice Address - Fax:321-676-3644
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0039572174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD51333Medicare UPIN