Provider Demographics
NPI:1700820909
Name:ELISEO M. ROQUIZ MD
Entity Type:Organization
Organization Name:ELISEO M. ROQUIZ MD
Other - Org Name:MILLCREEK ANESTHESIA SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ANESTHESIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELISEO
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROQUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-454-8885
Mailing Address - Street 1:PO BOX 1149
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16512-1149
Mailing Address - Country:US
Mailing Address - Phone:814-454-8885
Mailing Address - Fax:814-456-3856
Practice Address - Street 1:5515 PEACH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-2603
Practice Address - Country:US
Practice Address - Phone:814-454-8885
Practice Address - Fax:814-456-3856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022695E207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty