Provider Demographics
NPI:1275542854
Name:ROACH, DEE ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DEE
Middle Name:ALAN
Last Name:ROACH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:997 W INTERSTATE 20
Mailing Address - Street 2:FAMILY MEDICAL ASSOCIATES
Mailing Address - City:COLORADO CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79512-2685
Mailing Address - Country:US
Mailing Address - Phone:325-728-2963
Mailing Address - Fax:325-728-2420
Practice Address - Street 1:997 W INTERSTATE 20
Practice Address - Street 2:FAMILY MEDICAL ASSOCIATES
Practice Address - City:COLORADO CITY
Practice Address - State:TX
Practice Address - Zip Code:79512-2685
Practice Address - Country:US
Practice Address - Phone:325-728-2963
Practice Address - Fax:325-728-2420
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2014-04-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXG5542207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87T821OtherBLUE CROSS BLUE SHIELD
TX110416801Medicaid
TXB25953Medicare UPIN
TX110416801Medicaid