Provider Demographics
NPI:1588796437
Name:DURAND ROLON, ROBERTO SR (MD)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:DURAND ROLON
Suffix:SR
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:PO BOX 2220
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745
Mailing Address - Country:US
Mailing Address - Phone:787-888-0576
Mailing Address - Fax:787-888-0576
Practice Address - Street 1:CALLE GARCIA DE LA NOCEDA A4 VILLAS DE
Practice Address - Street 2:
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745
Practice Address - Country:US
Practice Address - Phone:787-888-0576
Practice Address - Fax:787-888-0576
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9512208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
82103Medicare PIN
E81969Medicare UPIN