Basic Information
| Provider Information | |||||||||
| NPI: | 1306818190 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROCCO | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5782 ADAMS AVE PKWY | ||||||||
| Address2: | |||||||||
| City: | OGDEN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 844056947 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019178020 | ||||||||
| FaxNumber: | 8019178001 | ||||||||
| Practice Location | |||||||||
| Address1: | 5782 ADAMS AVENUE PARKWAY | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON TERRACE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019178000 | ||||||||
| FaxNumber: | 8019178001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2006 | ||||||||
| LastUpdateDate: | 09/12/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 60233511205 | UT | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 005587209 | 01 | MEDICARE PART B | OTHER | 870680455011 | 05 | UT | MEDICAID | H65675 | 01 | PUBLIC EMPLOYEES | OTHER | 60233511200001 | 01 | HEALTHWISE | OTHER | 60233511200001 | 01 | BC OF WYO | OTHER | 60233511200001 | 01 | VALUECARE | OTHER | 60233511200001 | 01 | BCBS OF OTHER STATE | OTHER | 60233511200001 | 01 | FED BCBS | OTHER | 000055872 | 01 | MEDICARE PART B | OTHER | D6480 | 05 | UT | MEDICAID | 60233511200001 | 01 | BCBS | OTHER | 60233511200001 | 01 | BCBS MEDADVANTAGE | OTHER | 86192 | 01 | PUBLIC EMPLOYEES | OTHER |