Provider Demographics
NPI:1831134246
Name:ROLOSON, GARY J (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:J
Last Name:ROLOSON
Suffix:
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 1:3600 GASTON AVE
Mailing Address - Street 2:WADLEY TOWER, SUTE 261
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1800
Mailing Address - Country:US
Mailing Address - Phone:214-823-6492
Mailing Address - Fax:214-818-9180
Practice Address - Street 1:3600 GASTON AVE
Practice Address - Street 2:WADLEY TOWER, SUITE 261
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1800
Practice Address - Country:US
Practice Address - Phone:214-818-9100
Practice Address - Fax:214-818-9180
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3205207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8977K1OtherBLUE CROSS BLUE SHEILD
TXP00120165OtherRAILROAD MEDICARE
TX118798104Medicaid
TX8977K1Medicare ID - Type Unspecified
TX8977K1OtherBLUE CROSS BLUE SHEILD