Provider Demographics
NPI:1952822165
Name:ROCHELEAU, DENNIS J (DO)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:J
Last Name:ROCHELEAU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 N PIEDRAS STREET
Mailing Address - Street 2:WBAMC-GME
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79920-5001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:590 MEDICAL CENTER RD
Practice Address - Street 2:
Practice Address - City:FT. CAVAZOS
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:603-321-4214
Practice Address - Fax:915-742-4363
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NE2048207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program