Provider Demographics
NPI:1316123409
Name:DONALD C. ROA, MD,PA
Entity type:Organization
Organization Name:DONALD C. ROA, MD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-412-7099
Mailing Address - Street 1:1821 S SESAME SQUARE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8407
Mailing Address - Country:US
Mailing Address - Phone:956-412-7099
Mailing Address - Fax:956-412-7488
Practice Address - Street 1:1821 S SESAME SQUARE
Practice Address - Street 2:SUITE 9
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8407
Practice Address - Country:US
Practice Address - Phone:956-412-7099
Practice Address - Fax:956-412-7488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7141207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BC600OtherBC BS OF TX
TX193706201Medicaid
TX00Y979Medicare PIN