Jason Roach, PA-C

NPI #1104179795 in Peoria, Illinois

Provider Information

NPI Number: 1104179795
Entity Type: Individual
Name: Jason Roach, PA-C
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant
Credential: PA-C
Enumeration Date: Oct 19, 2012
Last Updated: Oct 19, 2012

Practice Location

Address: 530 NE GLEN OAK AVE
City: Peoria
State: Illinois
ZIP Code: 61637-0001
Phone: (309) 655-2036

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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