Basic Information
| Provider Information | |||||||||
| NPI: | 1083848998 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JAMES C. ROCKWELL MD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 50150 | ||||||||
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| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980150150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252285228 | ||||||||
| FaxNumber: | 4252285733 | ||||||||
| Practice Location | |||||||||
| Address1: | 130 CARLANNA LAKE RD | ||||||||
| Address2: | |||||||||
| City: | KETCHIKAN | ||||||||
| State: | AK | ||||||||
| PostalCode: | 999015611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9072471515 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2009 | ||||||||
| LastUpdateDate: | 06/18/2009 | ||||||||
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| AuthorizedOfficialLastName: | ROCKWELL | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | C. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4252285228 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 2782 | AK | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | MD27823 | 05 | AK | MEDICAID |