Provider Demographics
NPI:1487610564
Name:ROLLER, RICHARD ALLEN (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALLEN
Last Name:ROLLER
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 E LEE ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-2368
Mailing Address - Country:US
Mailing Address - Phone:334-348-8818
Mailing Address - Fax:334-393-8773
Practice Address - Street 1:805 E LEE ST
Practice Address - Street 2:SUITE C
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-2368
Practice Address - Country:US
Practice Address - Phone:334-348-8818
Practice Address - Fax:334-393-8773
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL29971207QA0505X, 208D00000X, 2083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine