Provider Demographics
NPI:1376673467
Name:ROLLINGS, JOHN WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILLIAM
Last Name:ROLLINGS
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 1:236 REES HILL RD SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-9111
Mailing Address - Country:US
Mailing Address - Phone:503-585-2303
Mailing Address - Fax:
Practice Address - Street 1:435 LANCASTER DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4729
Practice Address - Country:US
Practice Address - Phone:503-585-6388
Practice Address - Fax:503-585-0669
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12174207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR066498Medicaid
ORM4003 01OtherPACIFIC SOURCE
OR0057325873360OtherREGENCE BCBS OF OREGON
OR0169990022OtherPROVIDENCE HEALTH PLANS
OR0169990022OtherPROVIDENCE HEALTH PLANS
OR0000BHNKQMedicare ID - Type Unspecified