Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DS041793 | PA |
Y | 204E00000X | Oral & Maxillofacial Surgeon | MD465831 | PA |
NPI | 1083725964 |
---|---|
Provider Name | Dr. Jeffrey W Rockacy |
First Address | Pittsburgh, PA 15242 |
Second Address | Warrendale, PA 15086-1114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 23/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5N371 | BCBS MEDICAL (01) | AR |
I11919 | (02) |