Provider Demographics
NPI:1942734181
Name:ROLAND, DERRICK A (DPM)
Entity Type:Individual
Prefix:
First Name:DERRICK
Middle Name:A
Last Name:ROLAND
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8870 CEDAR SPRINGS LN STE 104
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-5407
Mailing Address - Country:US
Mailing Address - Phone:865-686-8486
Mailing Address - Fax:865-686-8486
Practice Address - Street 1:8870 CEDAR SPRINGS LN STE 104
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-5407
Practice Address - Country:US
Practice Address - Phone:865-686-8486
Practice Address - Fax:865-686-8486
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-14
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN895213ES0103X
KY262098213ES0103X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program