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General NPI Number Information
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NPI Number | 1205071065
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Entity Type | Individual
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Provider Name | TIMOTHY JON ROLLE M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/09/2008
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Last Update Date | 01/03/2019
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Provider Practice Location Address
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Address Line | 8020 CONSTITUTION PL NE SUITE 202
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-7607
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Country | US
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Telephone | 505-998-3096
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Fax | 505-998-3100
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Provider Business Mailing Address
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Address Line | 5344 S ARABIAN DR
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City | SIERRA VISTA
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State | AZ
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Zip | 85650-9199
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Country | US
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Telephone | 705-764-4102
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Fax |
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD2016-0801
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License Number State | NM
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