Provider Demographics
NPI:1417018045
Name:ROLLINS, DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:ROLLINS
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 1:8374 W CAPOVILLA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-3305
Mailing Address - Country:US
Mailing Address - Phone:702-270-8210
Mailing Address - Fax:702-270-8315
Practice Address - Street 1:8374 W CAPOVILLA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-3305
Practice Address - Country:US
Practice Address - Phone:702-270-8210
Practice Address - Fax:702-270-8315
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11491207R00000X, 207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVI41127Medicare UPIN
NV101281Medicare ID - Type Unspecified