Healthcare Provider Details

I. General information

NPI: 1174529028
Provider Name (Legal Business Name): FREDERICK W. ROCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 HOSPITAL DR
NORTHPORT AL
35476-3360
US

IV. Provider business mailing address

2151 OLD ROCKY RIDGE RD STE 106
BIRMINGHAM AL
35216-7251
US

V. Phone/Fax

Practice location:
  • Phone: 205-989-1080
  • Fax: 205-989-1087
Mailing address:
  • Phone: 205-989-1080
  • Fax: 205-989-1087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number11613
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: