Individual
DR. JENNA ROACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2000 TYBEE LN, LAKE CHARLES, LA 70605-4171
(337) 433-7272
(337) 433-0730
Mailing address
2000 TYBEE LN, LAKE CHARLES, LA 70605-4171
(337) 433-7272
(337) 433-0730
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
321797
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
321797
STATE MEDICAL LICENSE
LA
Enumeration date
03/30/2016
Last updated
01/30/2020
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