Basic Information
| Provider Information | |||||||||
| NPI: | 1982605374 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROEHM | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4189 | ||||||||
| Address2: | AUSTIN HEART | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787654189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122064300 | ||||||||
| FaxNumber: | 5122064350 | ||||||||
| Practice Location | |||||||||
| Address1: | 7200 WYOMING SPGS | ||||||||
| Address2: | STE 1400, AUSTIN HEART, ROUND ROCK #1 | ||||||||
| City: | ROUND ROCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786814303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122442263 | ||||||||
| FaxNumber: | 5122440846 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | F4441 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 048695 | 01 | GREAT WEST | OTHER | 78681-C002 | 01 | CHAMPUS / TRICARE | OTHER | 50473 | 01 | TX | FIRST HEALTH | OTHER | 832880 | 01 | TX | BC/BS | OTHER | 12827253 | 05 | TX | MEDICAID | 324409 | 01 | USA MANAGED CARE | OTHER | 4313543 | 01 | AETNA / TRS | OTHER |