Provider Demographics
NPI:1154362010
Name:ROQUE, JOSE M (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:M
Last Name:ROQUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:230 S MAIN ST
Mailing Address - Street 2:SUITE 215
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3851
Mailing Address - Country:US
Mailing Address - Phone:714-937-9400
Mailing Address - Fax:714-937-9404
Practice Address - Street 1:230 S MAIN ST
Practice Address - Street 2:SUITE 215
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3851
Practice Address - Country:US
Practice Address - Phone:714-937-9400
Practice Address - Fax:714-937-9404
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG71898207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF61831Medicare UPIN