Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 036113684 | IL |
N | 208600000X | Surgeon | 036113684 | IL |
Y | 2086X0206X | Surgical Oncologist | 56692 | VA |
NPI | 1316195159 |
---|---|
Provider Name | Dr. Paul Bryan Roach |
First Address | Chesapeake, VA 23322-4041 |
Second Address | Portsmouth, VA 23708-2111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2008 |
Last Update Date | 29/04/2021 |