Individual
CHARLES ROLLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10720 E SOUTHERN AVE, SUITE 116, MESA, AZ 85209-3810
(480) 365-0050
(480) 365-0049
Mailing address
10720 E SOUTHERN AVE, SUITE 116, MESA, AZ 85209-3810
(480) 365-0050
(480) 365-0049
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
42322
AZ
208000000X
Pediatrics Physician
R4P75
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500496
—
AZ
Enumeration date
07/17/2006
Last updated
11/25/2014
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