Provider Demographics
NPI:1932139409
Name:ROEBUCK, JOSEPH RAYMOND (PHD MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:RAYMOND
Last Name:ROEBUCK
Suffix:
Gender:M
Credentials:PHD 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 15069
Mailing Address - Street 2:DEPT OF RADIOLOGY, ROUTE 0793
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277
Mailing Address - Country:US
Mailing Address - Phone:941-955-0200
Mailing Address - Fax:888-959-4782
Practice Address - Street 1:3200 TRIDENT TERRACE
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652
Practice Address - Country:US
Practice Address - Phone:941-955-0200
Practice Address - Fax:888-959-4782
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2237972085R0202X
TX422472085R0202X
FLME 1093562085R0202X
CAA992222085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018949700Medicaid
MA2102650Medicaid
MAJ28799OtherBLUE CROSS BLUE SHIELD
FL018949700Medicaid
MA2102650Medicaid