Healthcare Provider Details

I. General information

NPI: 1912588377
Provider Name (Legal Business Name): AUSTIN ROLLINS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2021
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865 S WATSON RD
BUCKEYE AZ
85326-3469
US

IV. Provider business mailing address

13660 N 94TH DR STE D1
PEORIA AZ
85381-4275
US

V. Phone/Fax

Practice location:
  • Phone: 623-974-0522
  • Fax:
Mailing address:
  • Phone: 623-974-0522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0001112
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0001112
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: