Individual
DR. DAVID J ROACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 MALLARD CREEK RD, SUITE 406, LOUISVILLE, KY 40207-5166
(502) 895-4607
(502) 895-4586
Mailing address
100 MALLARD CREEK RD, SUITE 406, LOUISVILLE, KY 40207-5166
(502) 895-4607
(502) 895-4586
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
TP225
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100310450
—
KY
Enumeration date
04/17/2013
Last updated
08/25/2016
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