Provider Demographics
NPI:1164401139
Name:ROESLER, PAUL J
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:J
Last Name:ROESLER
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:PO BOX 23057
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33623-2057
Mailing Address - Country:US
Mailing Address - Phone:813-899-6226
Mailing Address - Fax:813-985-8006
Practice Address - Street 1:3100 E FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4613
Practice Address - Country:US
Practice Address - Phone:813-971-6000
Practice Address - Fax:813-985-8006
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 637262085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261682300Medicaid
FLE77887Medicare UPIN
FLO3140AMedicare ID - Type Unspecified