Individual
DR. TOM RIMBERT ROARK
Active
Individual
DR. TOM RIMBERT ROARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
L0913
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0021HW
BCBS GROUP BILLING ID
TX
01
—
00486U
MEDICARE GROUP BILLING #
TX
01
—
1245417294
GROUP NPI
TX
01
—
CK3641
RR MEDICARE GROUP ID #
TX
01
—
L0913
MEDICAL LICENSE
TX
Enumeration date
06/05/2006
Last updated
02/13/2008
Update your record
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