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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