Individual
MICHAEL DEWAYNE ROACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
605C DOUGLAS DR, ASHLAND, MO 65010-9088
(573) 657-9354
(573) 657-9694
Mailing address
605C DOUGLAS DR, ASHLAND, MO 65010-9088
(573) 657-9354
(573) 657-9694
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2012008079
MO
207Q00000X
Family Medicine Physician
4950
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1740592435
—
MO
Enumeration date
07/09/2010
Last updated
06/03/2024
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