Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | J8108 | TX |
NPI | 1073629259 |
---|---|
Provider Name | Kathleen Barrett Rockwood |
First Address | New Braunfels, TX 78130 |
Second Address | New Braunfels, TX 78130 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 12/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
035670101 | (05) | TX |
B61521 | (02) | TX |