Individual
JONATHON R ROULLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CAA
Contact information
Practice address
11700 N MERIDIAN ST, CARMEL, IN 46032-4656
(317) 577-4200
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
23865827
—
367H00000X
Anesthesiologist Assistant
Primary
75000146A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1101755112
ANTHEM PTAN
IN
01
—
23865827
NCCAA
—
Enumeration date
06/02/2017
Last updated
12/03/2024
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