Provider Demographics
NPI:1114903242
Name:ROLINS, HOWARD J (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:J
Last Name:ROLINS
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 1:2202 N FORBES BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-1412
Mailing Address - Country:US
Mailing Address - Phone:520-625-1760
Mailing Address - Fax:520-648-1394
Practice Address - Street 1:400 W CAMINO CASA VERDE
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-1945
Practice Address - Country:US
Practice Address - Phone:520-625-1760
Practice Address - Fax:520-648-1394
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24625207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ447541Medicaid
F69024Medicare UPIN
103452Medicare ID - Type Unspecified