Individual
MICHAEL L ROACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
712 AVIATION WAY, CALDWELL, ID 83605-1154
(208) 302-7100
(208) 302-7155
Mailing address
3340 E GOLDSTONE DR, MERIDIAN, ID 83642-1026
(208) 302-7500
(208) 302-7555
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M7815
ID
207Q00000X
Family Medicine Physician
MD203385
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805573200
—
ID
Enumeration date
06/21/2006
Last updated
08/27/2025
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