Provider Demographics
NPI:1205921038
Name:ROLLINS, RAY E (DO)
Entity type:Individual
Prefix:MR
First Name:RAY
Middle Name:E
Last Name:ROLLINS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3635 N. BELTLINE RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SUNNYVALE
Mailing Address - State:TX
Mailing Address - Zip Code:75182
Mailing Address - Country:US
Mailing Address - Phone:972-216-1500
Mailing Address - Fax:972-216-1300
Practice Address - Street 1:3635 N. BELTLINE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:SUNNYVALE
Practice Address - State:TX
Practice Address - Zip Code:75182
Practice Address - Country:US
Practice Address - Phone:972-216-1500
Practice Address - Fax:972-216-1300
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5552207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111498505Medicaid
TX111498505Medicaid
TX00FS74Medicare UPIN
TX8K1541Medicare PIN