Provider Demographics
NPI:1811987563
Name:ROA, DONALD C (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:C
Last Name:ROA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2813 N AUGUSTA NATIONAL DR
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-7452
Mailing Address - Country:US
Mailing Address - Phone:956-412-7099
Mailing Address - Fax:956-412-7488
Practice Address - Street 1:1821 S SESAME SQUARE
Practice Address - Street 2:SUITE 9
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8407
Practice Address - Country:US
Practice Address - Phone:956-412-7099
Practice Address - Fax:956-412-7488
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2011-04-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXL7141207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160634502Medicaid
TX8BC600OtherBCBS OF TX
TX8F7766Medicare PIN