Provider Demographics
NPI:1700856606
Name:EVERETT, ROLANDA R (MD)
Entity Type:Individual
Prefix:
First Name:ROLANDA
Middle Name:R
Last Name:EVERETT
Suffix:
Gender:F
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 1648
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97440-1648
Mailing Address - Country:US
Mailing Address - Phone:541-242-4026
Mailing Address - Fax:541-242-4363
Practice Address - Street 1:2000 N 19TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-2526
Practice Address - Country:US
Practice Address - Phone:541-746-5437
Practice Address - Fax:541-746-3753
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD21149208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR151138Medicaid
G39901Medicare UPIN
OR151138Medicaid