Provider Demographics
NPI:1184606964
Name:ROESLER, NATHAN R (MD)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:R
Last Name:ROESLER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:363 TYLER ST
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:TX
Mailing Address - Zip Code:77657-5988
Mailing Address - Country:US
Mailing Address - Phone:409-755-0041
Mailing Address - Fax:409-981-9086
Practice Address - Street 1:3127 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4609
Practice Address - Country:US
Practice Address - Phone:409-899-1433
Practice Address - Fax:409-981-9086
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-16
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXL8177208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI08297Medicare UPIN