Provider Demographics
NPI:1497805295
Name:ROCHE, MARTIN W (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:W
Last Name:ROCHE
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 1:4725 N FEDERAL HIGHWAY
Mailing Address - Street 2:ORTHOPEDIC CENTER
Mailing Address - City:FT. LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308
Mailing Address - Country:US
Mailing Address - Phone:954-958-4800
Mailing Address - Fax:954-958-4899
Practice Address - Street 1:4725 N FEDERAL HIGHWAY
Practice Address - Street 2:ORTHOPEDIC CENTER
Practice Address - City:FT. LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308
Practice Address - Country:US
Practice Address - Phone:954-958-4800
Practice Address - Fax:954-958-4899
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61777207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250439100Medicaid
FL32077Medicare ID - Type Unspecified