Provider Demographics
NPI:1427724277
Name:EVOLUTION MEDICINE PLLC
Entity type:Organization
Organization Name:EVOLUTION MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-658-0928
Mailing Address - Street 1:860 E RALPH HALL PKWY STE 44
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-6877
Mailing Address - Country:US
Mailing Address - Phone:972-658-0928
Mailing Address - Fax:972-672-6912
Practice Address - Street 1:860 E RALPH HALL PKWY STE 44
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6877
Practice Address - Country:US
Practice Address - Phone:972-658-0928
Practice Address - Fax:972-672-6912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty