MEDICARE: SAM EDWIN ROLON D.O.

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	207Q00000X	Family Medicine Physician	M5472	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8AK400	OTHER	TX	BCBSTX
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962616706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAM EDWIN ROLON D.O.

Provider Business Mailing Address
First Line	:	10857 KUYKENDAHL RD STE 130
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77382-2936
Country	:	US
Telephone Number	:	936-266-4150
Fax Number	:	936-266-4159

Provider Business Practice Location Address
First Line	:	8558 CREEKSIDE FOREST DR STE B
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77375-2175
Country	:	US
Telephone Number	:	832-534-7700
Fax Number	:

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

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	08/10/2025

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