Provider Demographics
NPI:1205288412
Name:ROLLER GYNECOLOGY LLC
Entity type:Organization
Organization Name:ROLLER GYNECOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROLLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:1813-333-5233
Mailing Address - Street 1:36739 STATE ROAD 52
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525-5101
Mailing Address - Country:US
Mailing Address - Phone:813-333-5233
Mailing Address - Fax:813-940-3234
Practice Address - Street 1:36739 STATE ROAD 52
Practice Address - Street 2:SUITE 101
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-5101
Practice Address - Country:US
Practice Address - Phone:813-333-5233
Practice Address - Fax:813-940-3234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-12
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty