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Individual
ELMER DEJESUS ROQUE
Active
Individual
ELMER DEJESUS ROQUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
00022416
AL
208000000X
Pediatrics Physician
Primary
00022416
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009910176
—
AL
05
—
392055922
—
AL
01
—
51060553
BCBS
AL
01
—
515165531
BCBS
AL
01
—
51516953
BCBS
AL
05
—
6309000054
—
AL
05
—
630901054
—
AL
05
—
630902054
—
AL
05
—
630903054
—
AL
01
—
P00040942
RAILROAD
AL
Enumeration date
07/23/2006
Last updated
03/30/2011
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