Healthcare Provider Details

I. General information

NPI: 1447607627
Provider Name (Legal Business Name): JOHN ROLLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15000 N 83RD AVE UNIT 300
PEORIA AZ
85381-2004
US

IV. Provider business mailing address

15000 N 83RD AVE UNIT 300
PEORIA AZ
85381-2004
US

V. Phone/Fax

Practice location:
  • Phone: 623-238-7490
  • Fax: 480-882-5019
Mailing address:
  • Phone: 623-238-7490
  • Fax: 480-882-5019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number04-42260
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number70118
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: