Individual
TIMOTHY JON ROLLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8020 CONSTITUTION PL NE, SUITE 202, ALBUQUERQUE, NM 87110-7607
(505) 998-3096
(505) 998-3100
Mailing address
5344 S ARABIAN DR, SIERRA VISTA, AZ 85650-9199
(705) 764-4102
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD2016-0801
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
539599YLGQ
MEDICARE PTAN
NM
01
—
539599YN90
MEDICARE PTAN
NM
Enumeration date
12/09/2008
Last updated
01/03/2019
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