Provider Demographics
NPI:1124088612
Name:EIJSINK-ROEHR, STEPHANIE (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:
Last Name:EIJSINK-ROEHR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10515 N ORACLE RD STE 185
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-9378
Mailing Address - Country:US
Mailing Address - Phone:520-585-5878
Mailing Address - Fax:
Practice Address - Street 1:10515 N ORACLE RD STE 185
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85737-9378
Practice Address - Country:US
Practice Address - Phone:520-585-5878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9010207P00000X, 207Q00000X
AZ59892207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1297749-07OtherCSHCN
TX930114197OtherRR/MEDICARE
TX1297749-06Medicaid
TX8F2220OtherBLUE SHIELD
TXG08034Medicare UPIN
TX1297749-06Medicaid