Organization
CHARLES B ROLAND MD PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES B ROLAND MD (PRESIDENT)
(916) 635-6161
Entity
Organization
Contact information
Practice address
11216 TRINITY RIVER DR, #G, RANCHO CORDOVA, CA 95670-2961
(916) 635-6161
Mailing address
PO BOX 7096, STOCKTON, CA 95267-0096
(209) 956-7725
(209) 956-7733
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00C240040
BLUE SHIELD OF CALIFORNIA
CA
05
—
00C240040
—
CA
Enumeration date
11/14/2007
Last updated
12/14/2007
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