Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 6709 | PR |
Y | 208600000X | Surgeon | 6709 | PR |
NPI | 1003873704 |
---|---|
Provider Name | Carlos M Roque |
First Address | Vega Baja, PR 00694-7001 |
Second Address | Vega Baja, PR 00694-7001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 18/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C84223 | (02) | PR |