Provider Demographics
NPI:1184619157
Name:ROCA, JOSE RAMON (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:RAMON
Last Name:ROCA
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 1:2154 DUCK SLOUGH BLVD
Mailing Address - Street 2:STE 102
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-5073
Mailing Address - Country:US
Mailing Address - Phone:727-939-1737
Mailing Address - Fax:727-937-3018
Practice Address - Street 1:2154 DUCK SLOUGH BLVD
Practice Address - Street 2:STE 102
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-5073
Practice Address - Country:US
Practice Address - Phone:727-939-1737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0053991207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
01791400OtherST OF NY- EMPIRE
FL048681700Medicaid
3944143OtherCIGNA
174747OtherHEALTH CARE AND WELL CARE
FL07339OtherB/C B/S
110024795OtherRAILROAD MEDICARE
593044844OtherHUMANA- TRICARE
214772OtherAV MED- HMO
4245063OtherAETNA
214772OtherAV MED- HMO
FL048681700Medicaid