Provider Demographics
NPI:1255368239
Name:LAPORTE, ROE ALAN (PA)
Entity type:Individual
Prefix:
First Name:ROE
Middle Name:ALAN
Last Name:LAPORTE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 HWY 91 NORTH
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020
Mailing Address - Country:US
Mailing Address - Phone:903-463-8448
Mailing Address - Fax:903-463-7358
Practice Address - Street 1:1300 HWY 91 NORTH
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020
Practice Address - Country:US
Practice Address - Phone:903-463-8448
Practice Address - Fax:903-463-7358
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03416363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR89718Medicare UPIN
TX8A1548Medicare ID - Type Unspecified