Basic Information
| Provider Information | |||||||||
| NPI: | 1275586604 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROLFE | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | LYNNE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DAUGHERTY | ||||||||
| OtherFirstName: | DEBORAH | ||||||||
| OtherMiddleName: | LYNNE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 1239 | ||||||||
| Address2: | |||||||||
| City: | TROY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480991239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488246600 | ||||||||
| FaxNumber: | 8556186655 | ||||||||
| Practice Location | |||||||||
| Address1: | 4348 SOUTHPOINT BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322160986 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042811915 | ||||||||
| FaxNumber: | 9042811119 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 08/12/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35.128312 | OH | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 2016-00762 | NC | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 49368 | KY | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 39287 | SC | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | ME0074209 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 26979 | WV | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 53828 | TN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD043823 | DC | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 17733 | NH | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 0101261212 | VA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 075882 | GA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | E10294 | AR | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 257775500 | 05 | FL | MEDICAID |