Individual ProviderRichard G. RoetzheimFamily MedicineAllopathic & Osteopathic PhysiciansPractice Address12901 Bruce B Downs Blvd, Mdc 13, Tampa, FL 33612-4742(813) 974-2918(813) 974-2201PECOS EnrollmentBased on the most recent information from CMS, provider Richard G. Roetzheim does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1629007927Provider TypeIndividualFull NameRoetzheim, Richard G.CredentialMDGenderMaleSole ProprietorNoEnumeration Date7/1/2006Last Updated3/22/2021Contact InformationPractice LocationPractice Address12901 Bruce B Downs Blvd, Mdc 13, Tampa, FL 33612-4742Phone(813) 974-2918Fax(813) 974-3326Mailing LocationMailing AddressPO Box 917770, Orlando, FL 32891-0001Phone(813) 974-2201Fax(813) 974-4325Provider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicenseME48895FloridaProvider IdentifiersIDDescriptionIssuerID042972DescriptionOtherIssuerBLUE CROSS BLUE SHIELDFloridaID048822400DescriptionMedicaidIssuerUnlistedFlorida