Individual
JOHN B ROACH JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
17723 HUNTING BOW CIR, SUITE 101, LUTZ, FL 33558-5371
(813) 528-8744
(813) 528-8791
Mailing address
17723 HUNTING BOW CIR, SUITE 101, LUTZ, FL 33558-5371
(813) 528-8744
(813) 528-8791
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
LT06104
ME
208600000X
Surgery Physician
Primary
OS9566
FL
2086S0122X
Plastic and Reconstructive Surgery Physician
OS9566
FL
Other
Enumeration date
05/25/2006
Last updated
02/21/2014
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