Provider Demographics
NPI:1215121488
Name:ROESLER, TAMMY (MD)
Entity type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:
Last Name:ROESLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 LAKESIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509
Mailing Address - Country:US
Mailing Address - Phone:775-737-4707
Mailing Address - Fax:877-548-4638
Practice Address - Street 1:3725 LAKESIDE DRIVE
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509
Practice Address - Country:US
Practice Address - Phone:775-737-4707
Practice Address - Fax:877-548-4385
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12378208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002016499Medicaid