Provider Demographics
NPI:1376581330
Name:ROQUE, TAMMY ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:ELIZABETH
Last Name:ROQUE
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:2800 S HIGHWAY 75
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-9395
Practice Address - Country:US
Practice Address - Phone:903-892-9455
Practice Address - Fax:903-892-4910
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8588207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX125531401Medicaid
TX125534102Medicaid
TX8R1538OtherBLUE CROSS OF TEXAS
TX045813503OtherCSHCN
OK100082960AMedicaid
TX045813501Medicaid
TX830000053Medicare PIN
TX125534102Medicaid
OK100082960AMedicaid
TX84G563Medicare PIN