Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | 4301099790 | MI |
Y | 208200000X | Surgeon | 4301099790 | MI |
Y | 208600000X | Surgeon | 4301099790 | MI |
NPI | 1245497478 |
---|---|
Provider Name | Dr. Jason Andrew Rolls |
First Address | Detroit, MI 48201-2020 |
Second Address | Detroit, MI 48201-2020 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2008 |
Last Update Date | 09/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1245497478 | (05) | MI |