MEDICARE: ROBERTA ROWLAND DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	225	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AZ0193280	OTHER	AZ	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568459139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERTA ROWLAND DPM

Provider Business Mailing Address
First Line	:	1930 E THUNDERBIRD RD
Second Line	:	SUITE 104
City	:	PHOENIX
State	:	AZ
Zip	:	85023
Country	:	US
Telephone Number	:	602-938-3338
Fax Number	:	602-938-7343

Provider Business Practice Location Address
First Line	:	1930 W THUNDERBIRD RD
Second Line	:	SUITE 104
City	:	PHOENIX
State	:	AZ
Zip	:	85023-6369
Country	:	US
Telephone Number	:	602-938-3338
Fax Number	:	602-938-7343

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	03/20/2012

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