Individual
MARTIN G ROACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
7667 AL HIGHWAY 51 STE B, OPELIKA, AL 36804-2200
(334) 737-5557
(334) 727-5646
Mailing address
7667 AL HWY 51 SUITE B, OPELIKA, AL 36801
(334) 737-5557
(334) 737-5646
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DO866
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
263751277
TRICARE
—
01
—
51595037
BLUE CROSS BLUE SHIELD
AL
Enumeration date
09/15/2006
Last updated
04/22/2019
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