Provider Demographics
NPI:1972571743
Name:TYROCH, ROXANNE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROXANNE
Middle Name:MARIE
Last Name:TYROCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5823 N MESA ST # 537
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-4607
Mailing Address - Country:US
Mailing Address - Phone:915-261-4377
Mailing Address - Fax:915-532-5859
Practice Address - Street 1:154 N FESTIVAL DR # VILLA F
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-6266
Practice Address - Country:US
Practice Address - Phone:915-532-5858
Practice Address - Fax:915-532-5859
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1945207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX048651610Medicaid
TX048651611Medicaid
NM12538868Medicaid
TX8L15572Medicare PIN
TX048651611Medicaid
NM12538868Medicaid