Individual
JASON ROACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
530 NE GLEN OAK AVE, PEORIA, IL 61637-0001
(309) 655-2036
Mailing address
280 E GREENWOOD ST, MORTON, IL 61550-2572
(815) 674-0887
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085.004474
IL
Other
Enumeration date
10/19/2012
Last updated
10/19/2012
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