Provider Demographics
NPI:1255362919
Name:ROACHE, PAUL BYRON (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:BYRON
Last Name:ROACHE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2269 CHESTNUT ST
Mailing Address - Street 2:#975
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-2600
Mailing Address - Country:US
Mailing Address - Phone:415-447-0495
Mailing Address - Fax:415-447-0467
Practice Address - Street 1:45 CASTRO ST STE 337
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-1019
Practice Address - Country:US
Practice Address - Phone:415-447-0495
Practice Address - Fax:415-447-0467
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2018-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA48445207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00484450Medicare ID - Type Unspecified
CAG74535Medicare UPIN