Individual
KENNETH WILLIAM ROACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1000 N MAIN ST, SUITE #204, FUQUAY VARINA, NC 27526-2056
(919) 567-3709
Mailing address
605 ATTAIN ST, # 101, FUQUAY VARINA, NC 27526-1972
(919) 567-3709
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
200300401
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89134UY
—
NC
Enumeration date
05/31/2005
Last updated
02/06/2018
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