Provider Demographics
NPI:1679568075
Name:ROCH, DONITA J (PA)
Entity Type:Individual
Prefix:MRS
First Name:DONITA
Middle Name:J
Last Name:ROCH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7100 OAKMONT BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3909
Mailing Address - Country:US
Mailing Address - Phone:817-370-0400
Mailing Address - Fax:817-370-0448
Practice Address - Street 1:7100 OAKMONT BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3909
Practice Address - Country:US
Practice Address - Phone:817-370-0400
Practice Address - Fax:817-370-0448
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA00897207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
R54396Medicare UPIN
TX00370KMedicare ID - Type UnspecifiedGROUP
TX8D1184Medicare ID - Type Unspecified