Provider Demographics
NPI:1437115284
Name:ROLAND, DANIEL (PA01)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:ROLAND
Suffix:
Gender:M
Credentials:PA01
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 W 24TH ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6105
Mailing Address - Country:US
Mailing Address - Phone:928-341-9522
Mailing Address - Fax:928-341-8492
Practice Address - Street 1:1975 W 24TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6105
Practice Address - Country:US
Practice Address - Phone:928-341-9522
Practice Address - Fax:928-341-8492
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1131363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZMR0697118OtherDEA
AZMR0697118OtherDEA