Provider Demographics
NPI:1891788378
Name:ROQUIZ, ELISEO M (MD)
Entity Type:Individual
Prefix:DR
First Name:ELISEO
Middle Name:M
Last Name:ROQUIZ
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 1:225 W 25TH ST
Mailing Address - Street 2:SUITE 408
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-2703
Mailing Address - Country:US
Mailing Address - Phone:814-454-8885
Mailing Address - Fax:814-456-3856
Practice Address - Street 1:232 W 25TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16544-0002
Practice Address - Country:US
Practice Address - Phone:814-452-5000
Practice Address - Fax:814-452-5348
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022695E207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009192260006Medicaid
PA010625Medicare ID - Type Unspecified
PA0009192260006Medicaid