Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 114590 | MO |
NPI | 1184710170 |
---|---|
Provider Name | Dr. Todd Rockett |
First Address | Hartsburg, MO 65039-9456 |
Second Address | Jefferson City, MO 65101-1602 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G68320 | (02) | MO |