Individual
DR. JOHN M. ROACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
242 BERGER RD, PADUCAH, KY 42003-4522
(270) 366-0960
(271) 554-1108
Mailing address
242 BERGER RD, PADUCAH, KY 42003-4522
(270) 366-0960
(270) 554-1108
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
39216
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1427478700
NPI GROUP
KY
01
—
39216
KY STATE LICENSE
KY
05
—
64095565
—
KY
Enumeration date
05/24/2005
Last updated
10/15/2024
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