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General NPI Number Information
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NPI Number | 1538137930
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Entity Type | Individual
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Provider Name | BRICE STEELE ROLSTON M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/10/2006
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Last Update Date | 11/16/2010
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Provider Practice Location Address
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Address Line | 71107 HIGHWAY 21 SUITE 3
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City | COVINGTON
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State | LA
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Zip | 70433-7151
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Country | US
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Telephone | 985-893-5780
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Fax | 985-893-0601
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Provider Business Mailing Address
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Address Line | 187 GREENBRIAR BLVD SUITE A
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City | COVINGTON
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State | LA
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Zip | 70433-7234
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Country | US
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Telephone | 985-893-5780
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Fax | 985-893-0601
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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 | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 12914
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License Number State | LA
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