Provider Demographics
NPI:1689664989
Name:ROSCHMANN, ALFRED CARL (MD)
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:CARL
Last Name:ROSCHMANN
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:PO BOX 17916
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-1034
Mailing Address - Country:US
Mailing Address - Phone:888-896-9369
Mailing Address - Fax:775-852-6902
Practice Address - Street 1:218 QUINLAN ST # 372
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5314
Practice Address - Country:US
Practice Address - Phone:775-241-8553
Practice Address - Fax:775-852-6902
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8111207P00000X, 2085R0204X
TXJ61112085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX105120302OtherCSHCN
TX105120301Medicaid
TX86870JOtherBCBS
TX86870JMedicare ID - Type Unspecified
TXG16045Medicare UPIN