Individual
DR. PAUL JEFFREY ROACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1301 W 38TH ST, SUITE 400, AUSTIN, TX 78705-1000
(512) 324-3440
(512) 406-6513
Mailing address
4616 W HOWARD LN, AUSTIN, TX 78728-6300
(512) 324-8960
(512) 324-8906
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
J1370
TX
207RI0011X
Interventional Cardiology Physician
Primary
J1370
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
137563614
—
TX
05
—
137563615
—
TX
05
—
137563616
—
TX
05
—
137563617
—
TX
01
—
8CN870
BCBS
TX
01
—
8ET553
BCBS
TX
01
—
P00837339
RAILROAD MEDICARE
TX
Enumeration date
12/14/2005
Last updated
10/28/2016
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