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ROGER ROQUE MD LLC - Florida Company Profile

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Company Details

Entity Name: ROGER ROQUE MD LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 18 Apr 2022 (3 years ago)
Document Number: L22000184121
FEI/EIN Number 88-1809414
Address: 620 S LAKE ST., SUITE 2, LEESBURG, FL, 34748, US
Mail Address: P.O. BOX 491500, LEESBURG, FL, 34748, US
ZIP code: 34748
City: Leesburg
County: Lake
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
- Authorized Member -
SALVADOR-BACKER YESENIA Manager 109 N 7TH ST, LEESBURG, FL, 34748
WAGNER DAVID P Agent 700 WEST MAIN ST, LEESBURG, FL, 34748

National Provider Identifier

NPI Number:
1205571015
Certification Date:
2023-02-03

Authorized Person:

Name:
MR. DAVID P WAGNER
Role:
CHIEF FINANCIAL OFFICER
Phone:

Taxonomy:

Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
No
Selected Taxonomy:
261QM1300X - Multi-Specialty Clinic/Center
Is Primary:
Yes

Contacts:

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G24000113122 CLINICA FAMILIAR ACTIVE 2024-09-10 2029-12-31 - PO BOX 491500, LEESBURG, FL, 34749
G22000057073 ST FRANCIS PRIMARY CARE CLINIC ACTIVE 2022-05-05 2027-12-31 - POBOX 491500, LEESBURG, FL, 34749

Events

Event Type Filed Date Value Description
CHANGE OF MAILING ADDRESS 2022-07-25 620 S LAKE ST., SUITE 2, LEESBURG, FL 34748 -

Documents

Name Date
AMENDED ANNUAL REPORT 2024-05-22
ANNUAL REPORT 2024-01-26
ANNUAL REPORT 2023-01-12
Florida Limited Liability 2022-04-18

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Date of last update: 01 Aug 2025

Sources: Florida Department of State