Provider Demographics
NPI:1538137930
Name:ROLSTON, BRICE STEELE (MD)
Entity Type:Individual
Prefix:
First Name:BRICE
Middle Name:STEELE
Last Name:ROLSTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:187 GREENBRIAR BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7234
Mailing Address - Country:US
Mailing Address - Phone:985-893-5780
Mailing Address - Fax:985-893-0601
Practice Address - Street 1:71107 HIGHWAY 21
Practice Address - Street 2:SUITE 3
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7151
Practice Address - Country:US
Practice Address - Phone:985-893-5780
Practice Address - Fax:985-893-0601
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA12914207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1159166Medicaid
LAB89869Medicare UPIN
LA1159166Medicaid