Provider Demographics
NPI:1104894567
Name:ROEHR, JILL MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:MARIE
Last Name:ROEHR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3131 N MCMULLEN BOOTH RD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2008
Mailing Address - Country:US
Mailing Address - Phone:727-726-8871
Mailing Address - Fax:727-726-6822
Practice Address - Street 1:1258 W BAY DR
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-2242
Practice Address - Country:US
Practice Address - Phone:727-586-3751
Practice Address - Fax:727-587-9340
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83272208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0046994OtherCIGNA
FL2275420OtherUNITED
FL265755400Medicaid
FL5740708OtherAETNA
FL62735OtherBCBS
FL2275420OtherUNITED
FL62735OtherBCBS