Individual
JASON R ROLLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3533 SOUTHERN BLVD, STE 2100, KETTERING, OH 45429-1267
(937) 395-8556
(937) 522-7873
Mailing address
3533 SOUTHERN BLVD, STE 2100, KETTERING, OH 45429-1267
(937) 395-8556
(937) 522-7873
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
50-002592
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0080733
—
OH
Enumeration date
03/16/2007
Last updated
11/24/2020
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