Provider Demographics
NPI:1790713675
Name:ROLLER, JOSHUA E (MD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:E
Last Name:ROLLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8005 E 106TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-6600
Mailing Address - Country:US
Mailing Address - Phone:479-445-6460
Mailing Address - Fax:479-445-6719
Practice Address - Street 1:1280 E STEARNS ST
Practice Address - Street 2:SUITE 5
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-6241
Practice Address - Country:US
Practice Address - Phone:479-445-6460
Practice Address - Fax:479-445-6719
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE58193208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
I63308Medicare UPIN