Healthcare Provider Details

I. General information

NPI: 1891809752
Provider Name (Legal Business Name): ROCK VALLEY PATHOLOGIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5666 E STATE ST
ROCKFORD IL
61108-2425
US

IV. Provider business mailing address

5666 E STATE ST
ROCKFORD IL
61108-2425
US

V. Phone/Fax

Practice location:
  • Phone: 815-395-5105
  • Fax: 815-395-5364
Mailing address:
  • Phone: 815-395-5105
  • Fax: 815-395-5364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0104X
TaxonomyChemical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DENNIS DOLLETON
Title or Position: PRESIDENT
Credential: MD
Phone: 815-395-5110