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General NPI Number Information
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NPI Number | 1023254935
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Entity Type | Individual
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Provider Name | MICHAEL J ROYLANCE PA-C
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Gender | Male
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Dates
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Enumeration Date | 12/23/2008
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Last Update Date | 12/04/2012
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Provider Practice Location Address
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Address Line | 1717 WEST COWLES STREET
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City | FAIRBANKS
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State | AK
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Zip | 99701
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Country | US
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Telephone | 907-378-1997
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Fax | 907-458-3811
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Provider Business Mailing Address
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Address Line | 1717 WEST COWLES STREET
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City | FAIRBANKS
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State | AK
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Zip | 99701
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Country | US
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Telephone | 907-378-1997
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Fax | 907-458-3811
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PAD T 2002
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License Number State | AK
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 835
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License Number State | AK
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