Provider Demographics
NPI:1568459139
Name:ROWLAND, ROBERTA (DPM)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:ROWLAND
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 E THUNDERBIRD RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023
Mailing Address - Country:US
Mailing Address - Phone:602-938-3338
Mailing Address - Fax:602-938-7343
Practice Address - Street 1:1930 W THUNDERBIRD RD
Practice Address - Street 2:SUITE 104
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-6369
Practice Address - Country:US
Practice Address - Phone:602-938-3338
Practice Address - Fax:602-938-7343
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ225213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0193280OtherBLUE CROSS BLUE SHIELD
AZ701046Medicaid
AZ5071310001Medicare NSC
AZ701046Medicaid
AZAZ0193280OtherBLUE CROSS BLUE SHIELD