Healthcare Provider Details

I. General information

NPI: 1417018045
Provider Name (Legal Business Name): DANIEL ROLLINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 03/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8374 W CAPOVILLA AVE
LAS VEGAS NV
89113-3305
US

IV. Provider business mailing address

8374 W CAPOVILLA AVE
LAS VEGAS NV
89113-3305
US

V. Phone/Fax

Practice location:
  • Phone: 702-270-8210
  • Fax: 702-270-8315
Mailing address:
  • Phone: 702-270-8210
  • Fax: 702-270-8315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11491
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11491
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number11491
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: