Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 0101238201 | VA |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | P4504 | TX |
NPI | 1144219510 |
---|---|
Provider Name | Dr. Christopher James Roach |
First Address | Fort Sam Houston, TX 78234-4501 |
Second Address | Fort Sam Houston, TX 78234-4501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2005 |
Last Update Date | 22/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
356775201 | (05) | TX |