Healthcare Provider Details

I. General information

NPI: 1962279950
Provider Name (Legal Business Name): MATTHEW JAMES ROHLER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MATTHEW ROHLER PA

II. Dates (important events)

Enumeration Date: 12/08/2023
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 HWAY 95
BULLHEAD CITY AZ
86442-4334
US

IV. Provider business mailing address

3015 HWAY 95 STE 105
BULLHEAD CITY AZ
86442-4334
US

V. Phone/Fax

Practice location:
  • Phone: 928-763-2001
  • Fax: 928-763-2038
Mailing address:
  • Phone: 928-763-2001
  • Fax: 928-763-2038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10842
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: