MEDICARE: DR. DANIEL ROLLINS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	11491	NV
2	207Q00000X	Family Medicine Physician	11491	NV
3	207QG0300X	Geriatric Medicine (Family Medicine) Physician	11491	NV

General Provider Information

NPI Number	:	1417018045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL ROLLINS MD

Provider Business Mailing Address
First Line	:	8374 W CAPOVILLA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-3305
Country	:	US
Telephone Number	:	702-270-8210
Fax Number	:	702-270-8315

Provider Business Practice Location Address
First Line	:	8374 W CAPOVILLA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-3305
Country	:	US
Telephone Number	:	702-270-8210
Fax Number	:	702-270-8315

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	03/18/2009

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