Provider Demographics
NPI:1861717092
Name:ROA, PAUL E (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:E
Last Name:ROA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1951 SW 172ND AVE STE 314
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-5614
Mailing Address - Country:US
Mailing Address - Phone:549-447-5206
Mailing Address - Fax:954-447-5259
Practice Address - Street 1:1951 SW 172ND AVE STE 314
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029
Practice Address - Country:US
Practice Address - Phone:549-447-5206
Practice Address - Fax:954-447-5259
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME123129207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15572900Medicaid