ROGER C ROQUE MD PA
Marriage and Family Therapists at Bay St, Eustis, FL

License number
Florida ME0070970
Category
Osteopathic Medicine
Type
Family Medicine
Owner
Name: ROGER CAGANDAHAN ROQUE M.D.
Title: FAMILY PHYSICIAN
Phone: (352) 357-1014
Address
Address
720 N Bay St SUITE 8, Eustis, FL 32726
National Provider ID: 1932215043
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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ROGER C. ROQUE, M.D., PA

720 N Bay St SUITE 8, Eustis, FL 32726

Status:
Inactive
Industry:
Medical Doctor's Office
Inactive reason:
AMENDMENT
Registration:
Aug 4, 2006
Inactive since:
May 8, 2014
State ID:
P06000102328
Business type:
Florida Profit Corporation
Secretarys:
Roger C Roque (Director), 720 N Bay St SUITE 8, Eustis, FL 32726 (Physical),Cathy Sloan (Secretary), 720 N Bay St SUITE 8, Eustis, FL 32726 (Physical),Meliza A. Roque Secretary, inactive
Agent:
Cb&G Services,Inc,Altamonte Park, Altamonte Springs, FL 32701 (Physical)
EIN:
205321608

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