Individual
DR. CRYSTAL GRACE ROE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
601 CLARA BARTON BLVD STE 340, GARLAND, TX 75042-5755
(469) 800-2279
Mailing address
5423 OWENWOOD AVE, DALLAS, TX 75223
(817) 964-0602
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
BP10054377
TX
207Q00000X
Family Medicine Physician
R4313
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
593905
PHYSICIAN IN TRAINING PERMIT
TX
01
—
R4313
TEXAS MEDICAL BOARD
TX
Enumeration date
05/22/2015
Last updated
10/11/2017
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