Provider Demographics
NPI:1659403814
Name:MONIE', PAUL ROCH (MD, MPH)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ROCH
Last Name:MONIE'
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:ERIC
Other - Last Name:MONIE'
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3900 S ZINTEL WAY
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338
Mailing Address - Country:US
Mailing Address - Phone:509-942-3627
Mailing Address - Fax:509-942-2268
Practice Address - Street 1:1135 JADWIN AVE
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3434
Practice Address - Country:US
Practice Address - Phone:509-942-3300
Practice Address - Fax:509-942-1868
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60144946207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500624684Medicaid
WA1659403814Medicaid
WA0305758OtherL&I NUMBER
WA0305758OtherL&I NUMBER