| Roger Roque Md Llc | |
|
620 S Lake St Ste 2 Leesburg FL 34748-6059 | |
| (352) 314-6589 | |
| Not Available |
| Full Name | Roger Roque Md Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 620 S Lake St Ste 2, Leesburg, Florida |
| Authorized Official Name and Position | David P Wagner (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 3212045222 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Roger Roque Md Llc Po Box 491500 Leesburg FL 34749-1500 Ph: (352) 314-6589 | Roger Roque Md Llc 620 S Lake St Ste 2 Leesburg FL 34748-6059 Ph: (352) 314-6589 |
| NPI Number | 1205571015 |
|---|---|
| Provider Enumeration Date | 05/05/2022 |
| Last Update Date | 02/03/2023 |
| Medicare PECOS PAC ID | 3779962451 |
|---|---|
| Medicare Enrollment ID | O20220627002279 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205571015 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Rhonda D Ringer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871548891 PECOS PAC ID: 4587685136 Enrollment ID: I20051212000500 |
| Provider Name | William H Weaver |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1699701565 PECOS PAC ID: 7810979598 Enrollment ID: I20060328000032 |
| Provider Name | Roger C Roque |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437156916 PECOS PAC ID: 4981603560 Enrollment ID: I20070207000629 |
| Provider Name | Amanda Renee Lee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184353666 PECOS PAC ID: 1254711641 Enrollment ID: I20220701000300 |
| Provider Name | Ronda Spilliard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447910062 PECOS PAC ID: 4688057847 Enrollment ID: I20220822000075 |
| Provider Name | Ashley Michele Tyce |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558073924 PECOS PAC ID: 0345610176 Enrollment ID: I20230111003245 |
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