Provider Demographics
NPI:1235111477
Name:ROE, EDWARD J III (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:J
Last Name:ROE
Suffix:III
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 1:655 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-6511
Mailing Address - Country:US
Mailing Address - Phone:904-244-4405
Mailing Address - Fax:904-244-4508
Practice Address - Street 1:655 W 8TH ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-244-4405
Practice Address - Fax:904-244-4508
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00025819207P00000X
FLME 118390207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051520255OtherBCBS PROVIDER NUMBER
AL051520255Medicaid
ALP00126967OtherRRMC PROVIDER NUMBER
ALP00126967OtherRRMC PROVIDER NUMBER
ALE58986Medicare UPIN
AL051520255Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER