Provider Demographics
NPI:1033419429
Name:JAMIS, ROEL CONRAD
Entity Type:Individual
Prefix:DR
First Name:ROEL CONRAD
Middle Name:
Last Name:JAMIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 WOODMONT BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-5250
Mailing Address - Country:US
Mailing Address - Phone:615-314-5257
Mailing Address - Fax:
Practice Address - Street 1:17674 N LITCHFIELD RD
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2478
Practice Address - Country:US
Practice Address - Phone:623-281-3001
Practice Address - Fax:623-281-3003
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036133872207R00000X
AZ58522207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine