Provider Demographics
NPI:1205837689
Name:ROCHE, JOHN P (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:ROCHE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:601 7TH ST S STE 295
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4748
Mailing Address - Country:US
Mailing Address - Phone:727-553-7100
Mailing Address - Fax:727-553-7198
Practice Address - Street 1:601 7TH ST S STE 295
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4748
Practice Address - Country:US
Practice Address - Phone:727-553-7100
Practice Address - Fax:727-553-7198
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301501449207Y00000X
FLME165334207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG91028Medicare UPIN