Provider Demographics
NPI:1083234017
Name:ROEHRKASSE, RICHARD LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LYNN
Last Name:ROEHRKASSE
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 1:18025 ALEXANDRA WAY
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95949-7356
Mailing Address - Country:US
Mailing Address - Phone:530-263-2371
Mailing Address - Fax:
Practice Address - Street 1:18025 ALEXANDRA WAY
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95949-7356
Practice Address - Country:US
Practice Address - Phone:530-272-6218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-20
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36880207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine