Doctor Name: | RICKY ROACH |
NPI Number: | 1376561779 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DPM |
License Number: | |
Business Practice Address: | 999 N Halstead Rd Ocean Springs, MS - 395643105 |
Business Phone Number: | 2288182801 |
Business Fax Number: | 2288182803 |
Mailing Address: | Po Box 6278, DIBERVILLE |
State: | MS |
Postal Code: | 395406278 |
Phone Number: | 2288182801 |
Fax Number: | 2288182803 |
NPI Enumeration Date: | 07/17/2006 |
NPI Last Update Date: | 03/25/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332B00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MS |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | |
Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |