Provider Demographics
NPI:1780665760
Name:ENGEL, ROLAND EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:ROLAND
Middle Name:EDWARD
Last Name:ENGEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:301 FISHER ST
Mailing Address - Street 2:81 MDTS/SGQX
Mailing Address - City:KEESLER AFB
Mailing Address - State:MS
Mailing Address - Zip Code:39534
Mailing Address - Country:US
Mailing Address - Phone:228-376-4891
Mailing Address - Fax:228-376-0043
Practice Address - Street 1:301 FISHER ST
Practice Address - Street 2:81 MDTS/SGQX
Practice Address - City:KEESLER AFB
Practice Address - State:MS
Practice Address - Zip Code:39534
Practice Address - Country:US
Practice Address - Phone:228-376-4891
Practice Address - Fax:228-376-0043
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2012-09-11
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Provider Licenses
StateLicense IDTaxonomies
CAG890692085R0001X
MN307472085R0001X
NC99-002112085R0001X, 2085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology