Provider Demographics
NPI:1821367996
Name:ROLLMAN, JEFFREY MICHAEL (PA-C)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MICHAEL
Last Name:ROLLMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 AREA BRANCH MEDICAL CLINIC (MCMH)
Mailing Address - Street 2:BLDG 13127
Mailing Address - City:CAMP PENDLETON
Mailing Address - State:CA
Mailing Address - Zip Code:92596
Mailing Address - Country:US
Mailing Address - Phone:760-725-8007
Mailing Address - Fax:
Practice Address - Street 1:13 AREA BRANCH MEDICAL CLINIC (MCMH)
Practice Address - Street 2:BLDG 13127
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92596
Practice Address - Country:US
Practice Address - Phone:760-725-8007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant