Provider Demographics
NPI:1255726675
Name:ROQUE, DAVID O (PA)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:O
Last Name:ROQUE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:6360 PRESIDENTIAL CT STE 1
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-3501
Mailing Address - Country:US
Mailing Address - Phone:786-377-5643
Mailing Address - Fax:786-802-2011
Practice Address - Street 1:6360 PRESIDENTIAL CT STE 1
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3501
Practice Address - Country:US
Practice Address - Phone:786-377-5643
Practice Address - Fax:786-802-2011
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-02
Last Update Date:2024-04-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9107791363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant