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General NPI Number Information
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NPI Number | 1306807953
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Entity Type | Individual
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Provider Name | ALISHA JILLY ROFF PA
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Gender | Male
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Dates
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Enumeration Date | 03/31/2006
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Last Update Date | 11/19/2018
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Provider Practice Location Address
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Address Line | 304 S. 22ND STREET
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City | TEMPLE
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State | TX
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Zip | 76501
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Country | US
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Telephone | 254-298-7041
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Fax |
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Provider Business Mailing Address
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Address Line | 304 S. 22ND STREET
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City | TEMPLE
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State | TX
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Zip | 76501
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Country | US
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Telephone | 254-298-7041
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA02772
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License Number State | TX
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