Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | P6712 | TX |
N | 207Q00000X | Family Doctor | OS10510 | FL |
Y | 207Q00000X | Family Doctor | P6712 | TX |
NPI | 1659502763 |
---|---|
Provider Name | Dr. Katrina Marie Roop |
First Address | Fort Worth, TX 76107-2553 |
Second Address | Fort Worth, TX 76107-2553 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2009 |
Last Update Date | 21/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
331456901 | (05) | TX |
331456902 | MEDICAID - OTHER COUNTY (01) | TX |
339886YL7A | MEDICARE - OTHER COUNTY (01) | TX |
P01427305 | RAILROAD MEDICARE PTAN (01) | TX |