Provider Demographics
NPI:1932137957
Name:ROA, ANTONIO BARIL (MD)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:BARIL
Last Name:ROA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:PO BOX 2829
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:FL
Mailing Address - Zip Code:33862-2829
Mailing Address - Country:US
Mailing Address - Phone:863-465-6200
Mailing Address - Fax:863-465-9217
Practice Address - Street 1:201 US HIGHWAY 27 S
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:FL
Practice Address - Zip Code:33852-7904
Practice Address - Country:US
Practice Address - Phone:863-465-6200
Practice Address - Fax:863-465-9217
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME42772207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068294200Medicaid
FL28123YMedicare UPIN
FL068294200Medicaid