Provider Demographics
NPI:1528080678
Name:ROCHE, TARI L (DO)
Entity type:Individual
Prefix:DR
First Name:TARI
Middle Name:L
Last Name:ROCHE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1211 24TH ST
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-2562
Mailing Address - Country:US
Mailing Address - Phone:360-299-4216
Mailing Address - Fax:360-299-1369
Practice Address - Street 1:2511 M AVE B
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-3897
Practice Address - Country:US
Practice Address - Phone:360-299-4211
Practice Address - Fax:360-299-4213
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001743207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8290066Medicaid
WA8290066Medicaid
WAF30893Medicare UPIN