Provider Demographics
NPI:1144530528
Name:ROLLY R. STEEN M.D. ASSOCIATED
Entity type:Organization
Organization Name:ROLLY R. STEEN M.D. ASSOCIATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ANESTHESIOLOIST
Authorized Official - Prefix:
Authorized Official - First Name:ROLLY
Authorized Official - Middle Name:R
Authorized Official - Last Name:STEEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-361-6772
Mailing Address - Street 1:8409 PICKWICK LN
Mailing Address - Street 2:PMB 102
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-5323
Mailing Address - Country:US
Mailing Address - Phone:214-361-6772
Mailing Address - Fax:214-361-6766
Practice Address - Street 1:6200 WEST PARKER ROAD
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-7938
Practice Address - Country:US
Practice Address - Phone:214-361-6772
Practice Address - Fax:214-361-6766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035846701Medicaid