Provider Demographics
NPI:1861449035
Name:ROFFERS, JOHN ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ANTHONY
Last Name:ROFFERS
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 1:525 W RIVER WOODS PKWY
Mailing Address - Street 2:STE 240
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-1010
Mailing Address - Country:US
Mailing Address - Phone:414-327-0777
Mailing Address - Fax:
Practice Address - Street 1:2025 E NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-2906
Practice Address - Country:US
Practice Address - Phone:414-961-4161
Practice Address - Fax:414-967-1778
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI30078-020208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI110027424OtherRAILROAD MEDICARE
WI31485100Medicaid
E03490Medicare UPIN
WI000146066Medicare PIN
WI31485100Medicaid