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Organization
ROLLER ENTERPRISES LLC
Active
Organization
ROLLER ENTERPRISES LLC
Active
Other names
John O. Roller, DPM
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN ORVILLE ROLLER D.P.M. (OWNER)
(417) 336-3210
Entity
Organization
Contact information
Practice address
1691 S BUSINESS HIGHWAY 65, HOLLISTER, MO 65672-6342
(417) 336-3210
(417) 336-3201
Mailing address
PO BOX 147, HOLLISTER, MO 65673-0147
(417) 336-3210
(417) 336-3201
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
000740
MO
213EP1101X
Primary Podiatric Medicine Podiatrist
000740
MO
213ER0200X
Radiology Podiatrist
000740
MO
213ES0103X
Foot & Ankle Surgery Podiatrist
000740
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
507427300
—
MO
01
—
CH2570
RR MCR
—
01
—
DF3458
RR MCR
—
Enumeration date
08/11/2006
Last updated
04/17/2012
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