Provider Demographics
NPI:1831145283
Name:DAVID, GERARD ROQUE (MD)
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:ROQUE
Last Name:DAVID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:605-312-7607
Mailing Address - Fax:605-312-7611
Practice Address - Street 1:1205 S GRANGE AVE
Practice Address - Street 2:STE 401
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-0407
Practice Address - Country:US
Practice Address - Phone:605-328-8120
Practice Address - Fax:605-328-8121
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2023-01-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SD5863207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS101313Medicare PIN
SDS8255Medicare PIN
SDP00360507Medicare PIN