MEDICARE: MR. GEORGE NORMAN ROLL PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA31941FL	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184795346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GEORGE NORMAN ROLL PA-C

Provider Business Mailing Address
First Line	:	5399 E COUNTY HIGHWAY 30A
Second Line	:	SUITE 5
City	:	SANTA ROSA BEACH
State	:	FL
Zip	:	32459-6717
Country	:	US
Telephone Number	:	850-231-6200
Fax Number	:	850-231-3500

Provider Business Practice Location Address
First Line	:	5399 EAST COUNTY HIGHWAY 30A
Second Line	:	SUITE 5
City	:	SANTA ROSA BEACH
State	:	FL
Zip	:	32459-6718
Country	:	US
Telephone Number	:	850-231-6200
Fax Number	:	850-231-3500

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2006
Last Update Date	:	12/18/2013

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