Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 01037016 | IN |
NPI | 1023072840 |
---|---|
Provider Name | Paris Roach |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Indianapolis, IN 46202-5111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 22/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200328550 | (05) | IN |
H35634 | (02) | IN |