Provider Demographics
NPI:1730263138
Name:ROLLINS, DAVID BRUCE (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BRUCE
Last Name:ROLLINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1524 MCHENRY AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4568
Mailing Address - Country:US
Mailing Address - Phone:209-575-5801
Mailing Address - Fax:209-575-0115
Practice Address - Street 1:1524 MCHENRY AVE STE 500
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4568
Practice Address - Country:US
Practice Address - Phone:209-575-5801
Practice Address - Fax:209-575-0115
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50655207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A51765Medicare UPIN
CA00G506550Medicare ID - Type Unspecified