Basic Information
| Provider Information | |||||||||
| NPI: | 1710335112 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROACH | ||||||||
| FirstName: | PATRICK | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1010 N KANSAS ST | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672143124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162686147 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8080 E CENTRAL AVE STE 250 | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672062367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166867327 | ||||||||
| FaxNumber: | 3166861557 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2016 | ||||||||
| LastUpdateDate: | 02/16/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 94-08894 | KS | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.