Provider Demographics
NPI:1538125497
Name:ROACH, WILLIAM JOHN MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOHN MARK
Last Name:ROACH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1860 S CENTRAL ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-4418
Mailing Address - Country:US
Mailing Address - Phone:559-738-8584
Mailing Address - Fax:559-733-4355
Practice Address - Street 1:1860 S CENTRAL ST
Practice Address - Street 2:SUITE D
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-4418
Practice Address - Country:US
Practice Address - Phone:559-738-8584
Practice Address - Fax:559-733-4355
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2008-10-01
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Provider Licenses
StateLicense IDTaxonomies
CAA50330207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A503300Medicare PIN