Provider Demographics
NPI:1275586604
Name:ROLFE, DEBORAH LYNNE (MD)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:LYNNE
Last Name:ROLFE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:LYNNE
Other - Last Name:DAUGHERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-1239
Mailing Address - Country:US
Mailing Address - Phone:248-824-6600
Mailing Address - Fax:855-618-6655
Practice Address - Street 1:4348 SOUTHPOINT BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-0986
Practice Address - Country:US
Practice Address - Phone:904-281-1915
Practice Address - Fax:904-281-1119
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.128312207Q00000X
NC2016-00762207Q00000X
KY49368207Q00000X
SC39287207Q00000X
FLME0074209207Q00000X
WV26979207Q00000X
TN53828207Q00000X
DCMD043823207Q00000X
NH17733207Q00000X
VA0101261212207Q00000X
GA075882207Q00000X
ARE10294207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257775500Medicaid
FL257775500Medicaid