Individual
DONALD MICHAEL ROACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
100 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5238
(740) 441-8058
Mailing address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5238
(740) 441-8058
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
COA.9133-NA
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000497528
ANTHEM BCBS
—
01
—
001917039
MOUNTAIN STATE BCBS
—
05
—
2701446
—
OH
05
—
3810007256
—
WV
01
—
P00356781
RR MEDICARE
OH
Enumeration date
10/23/2006
Last updated
11/25/2020
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