Provider Demographics
NPI:1043388267
Name:ROLLER, ALBERT E (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:E
Last Name:ROLLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1095 LOS PALOS DRIVE
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3916
Mailing Address - Country:US
Mailing Address - Phone:831-775-0205
Mailing Address - Fax:831-775-0206
Practice Address - Street 1:1095 LOS PALOS DRIVE
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3916
Practice Address - Country:US
Practice Address - Phone:831-775-0205
Practice Address - Fax:831-775-0206
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG11992207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G119920Medicaid
CA00G119920Medicaid
CA00G119920Medicare PIN