Provider Demographics
NPI:1225036692
Name:ROLON, JUAN C (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:C
Last Name:ROLON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1900 N OREGON ST
Mailing Address - Street 2:305
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-3351
Mailing Address - Country:US
Mailing Address - Phone:915-225-3822
Mailing Address - Fax:915-225-3832
Practice Address - Street 1:125 W HAGUE RD
Practice Address - Street 2:260
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5814
Practice Address - Country:US
Practice Address - Phone:915-225-3818
Practice Address - Fax:915-225-3832
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE7254207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX031917001Medicaid
TX031917001Medicaid