=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861417412
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JON MICHAEL ROWLAND M.D., PHD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 747 52ND ST ROOM 238
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94609-1809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-428-3162
-----------------------------------------------------
Fax | 510-601-3915
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 252 DONALD DR
-----------------------------------------------------
City | MORAGA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94556-2310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-631-7096
-----------------------------------------------------
Fax | 510-601-3915
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207ZP0213X
-----------------------------------------------------
Taxonomy Name | Pediatric Pathology Physician
-----------------------------------------------------
License Number | G64565
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------