Healthcare Provider Details

I. General information

NPI: 1134137607
Provider Name (Legal Business Name): TANIA SANDRA ROWLAND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 E STONER AVE OVERTON BROOKS VAMC PATH & LAB MED SVC (113)
SHREVEPORT LA
71101-4243
US

IV. Provider business mailing address

6726 GILBERT DR
SHREVEPORT LA
71106-3402
US

V. Phone/Fax

Practice location:
  • Phone: 318-221-8411
  • Fax: 318-424-6093
Mailing address:
  • Phone: 318-861-5722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number01050088A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: