# MARTIN M ROCHE MD PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003010380
- **Authorized official:** MARTIN M ROCHE MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (954) 462-7558

## Contact information

- **Practice address:** 500 SE 17TH ST, SUITE 100, FT LAUDERDALE, FL 33316-2547
- **Practice address phone:** (954) 462-7558
- **Practice address fax:** (954) 525-5820
- **Mailing address:** 500 SE 17TH ST, SUITE 100, FT LAUDERDALE, FL 33316-2547
- **Mailing address phone:** (954) 462-7558
- **Mailing address fax:** (954) 525-5820

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/12/2007
- **Last updated:** 07/28/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 06962 | BLUECROSS OF FLORIDA | FL |