Healthcare Provider Details

I. General information

NPI: 1245233162
Provider Name (Legal Business Name): BRUCE JAMES ROWLAND D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 11/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 HOLIDAY LANE STE 400
FULTON KY
42041
US

IV. Provider business mailing address

2002 HOLIDAY LANE, STE 400
FULTON KY
42041
US

V. Phone/Fax

Practice location:
  • Phone: 270-472-8399
  • Fax: 270-472-8398
Mailing address:
  • Phone: 270-472-8399
  • Fax: 270-472-8398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number02178
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: