Provider Demographics
NPI:1992811483
Name:ROLLER, PAUL D (MD)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:D
Last Name:ROLLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LAKESHORE DRIVE
Mailing Address - Street 2:STE 200
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209
Mailing Address - Country:US
Mailing Address - Phone:205-916-0105
Mailing Address - Fax:205-916-0913
Practice Address - Street 1:1 LAKESHORE DRIVE
Practice Address - Street 2:STE 200
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209
Practice Address - Country:US
Practice Address - Phone:205-916-0105
Practice Address - Fax:205-916-0913
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18110207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051550174Medicaid
AL3800017772OtherMEDICARE RAILROAD
ALF79816Medicare UPIN
AL051550174Medicare PIN