Provider Demographics
NPI:1114997913
Name:ROE, CHESTER THOMAS III (MD)
Entity Type:Individual
Prefix:DR
First Name:CHESTER
Middle Name:THOMAS
Last Name:ROE
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4999 E KENTUCKY AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-3901
Mailing Address - Country:US
Mailing Address - Phone:303-758-5477
Mailing Address - Fax:303-758-3069
Practice Address - Street 1:4999 E KENTUCKY AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-3901
Practice Address - Country:US
Practice Address - Phone:303-758-5477
Practice Address - Fax:303-758-3069
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2010-05-12
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Provider Licenses
StateLicense IDTaxonomies
CO24061207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01240613Medicaid
COE60789Medicare UPIN
CO01240613Medicaid