Basic Information
| Provider Information | |||||||||
| NPI: | 1245233162 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROWLAND | ||||||||
| FirstName: | BRUCE | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2002 HOLIDAY LANE, | ||||||||
| Address2: | STE 400 | ||||||||
| City: | FULTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 42041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2704728399 | ||||||||
| FaxNumber: | 2704728398 | ||||||||
| Practice Location | |||||||||
| Address1: | 2002 HOLIDAY LANE | ||||||||
| Address2: | STE 400 | ||||||||
| City: | FULTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 42041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2704728399 | ||||||||
| FaxNumber: | 2704728398 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2005 | ||||||||
| LastUpdateDate: | 11/11/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 02178 | KY | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 64021785 | 05 | KY | MEDICAID | 000000612885 | 01 | KY | KY BCBS | OTHER |