Provider Demographics
NPI:1073563193
Name:PESTER, ROLLIN DEAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROLLIN
Middle Name:DEAN
Last Name:PESTER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14546 BROOK HOLLOW BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-3810
Mailing Address - Country:US
Mailing Address - Phone:210-496-2321
Mailing Address - Fax:
Practice Address - Street 1:14546 BROOK HOLLOW BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-3810
Practice Address - Country:US
Practice Address - Phone:210-496-2321
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0772213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00RN52Medicare ID - Type Unspecified
TXT15254Medicare UPIN