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General NPI Number Information
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NPI Number | 1295291367
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Entity Type | Organization
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Legal Business Name | DIVERSE COMMUNITY HEALTHCARE PLLC
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Dates
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Enumeration Date | 02/14/2019
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Last Update Date | 02/16/2019
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Provider Practice Location Address
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Address Line | 21898 FM 1314 RD STE B
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City | PORTER
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State | TX
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Zip | 77365-7061
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Country | US
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Telephone | 281-354-2417
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Fax | 281-786-0267
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Provider Business Mailing Address
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Address Line | 21898 FM 1314 RD STE B
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City | PORTER
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State | TX
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Zip | 77365-7061
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Country | US
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Telephone | 281-354-2417
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Fax | 281-786-0267
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | DR. RANDALL ROLAND
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Credential | DO
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Telephone | 281-354-2417
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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