Individual
DR. JOEY EDWARD ROQUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4070 HIGHWAY 17, MURRELLS INLET, SC 29576-5033
(843) 652-1415
(843) 366-4387
Mailing address
PO BOX 847, CORDOVA, TN 38088-0847
(843) 652-1415
(843) 366-4387
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
41492
TN
208100000X
Physical Medicine & Rehabilitation Physician
Primary
81712
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
81712
STATE OF SOUTH CAROLINA MEDICAL LICENSE
SC
Enumeration date
09/01/2006
Last updated
07/31/2019
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