| Doctor Name: | WILLIAM CHAD ROASA |
| NPI Number: | 1093005472 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA-C |
| License Number: | 1097229 |
| Business Practice Address: | 57950 E Leavenworth Ave 22d Medical Group - Family Practice Clinic Mcconnell Afb, KS - 672213506 |
| Business Phone Number: | 3167596701 |
| Business Fax Number: | 3167591304 |
| Mailing Address: | 57950 E Leavenworth Ave, 22d Medical Group - Family Practice Clinic MCCONNELL AFB |
| State: | KS |
| Postal Code: | 672213506 |
| Phone Number: | 3167596701 |
| Fax Number: | 3167591304 |
| NPI Enumeration Date: | 04/19/2011 |
| NPI Last Update Date: | 04/19/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 1097229 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |