Provider Demographics
NPI:1720077050
Name:ROE, TOMMY GENE (DPM)
Entity Type:Individual
Prefix:DR
First Name:TOMMY
Middle Name:GENE
Last Name:ROE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 53056
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87153-3056
Mailing Address - Country:US
Mailing Address - Phone:505-565-1155
Mailing Address - Fax:505-565-1166
Practice Address - Street 1:9412 INDIAN SCHOOL RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2878
Practice Address - Country:US
Practice Address - Phone:505-565-1155
Practice Address - Fax:505-565-1166
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM279213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM015486OtherBCBS PROVIDER NUMBER
NM55003800Medicaid
NM84001780Medicaid
NMU89130Medicare UPIN
NM5068420001Medicare NSC