Organization
ROGER ROQUE MD LLC
Active
Other names
St Francis Primary Care Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID P WAGNER (CHIEF FINANCIAL OFFICER)
(321) 204-5222
Entity
Organization
Contact information
Practice address
620 S LAKE ST STE 2, LEESBURG, FL 34748-6059
(352) 314-6589
Mailing address
PO BOX 491500, LEESBURG, FL 34749-1500
(352) 314-6589
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
05/05/2022
Last updated
02/03/2023
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