Individual
DR. RANDOLPH W. ROLLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1025 S 6TH ST, SPRINGFIELD, IL 62703-2403
(217) 528-7541
Mailing address
1025 S 6TH ST, SPRINGFIELD, IL 62703-2403
(217) 528-7541
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
036-054648
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0360546648
—
IL
Enumeration date
09/23/2006
Last updated
08/19/2008
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