Provider Demographics
NPI:1588238331
Name:ROLSHOVEN, JOHN GABRIEL (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:GABRIEL
Last Name:ROLSHOVEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:GABRIEL KUNCHEFF
Other - Last Name:ROLSHOVEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3950 S COUNTRY CLUB RD STE 200
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85714-2227
Mailing Address - Country:US
Mailing Address - Phone:520-626-5582
Mailing Address - Fax:
Practice Address - Street 1:3950 S COUNTRY CLUB RD STE 200
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85714-2227
Practice Address - Country:US
Practice Address - Phone:520-626-5582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR78667207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty