Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 54182 | WI |
NPI | 1073635157 |
---|---|
Provider Name | Dr. Robert Michael Rock JR. |
First Address | Depere, WI 54115 |
Second Address | Green Bay, WI 54301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 18/08/2010 |