Healthcare Provider Details

I. General information

NPI: 1275531725
Provider Name (Legal Business Name): DOUGLAS BRENT ROCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 07/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 WELLINGTON AVE ST. MARY'S MEDICAL PAVILION, RADIATION ONCOLOGY
GRAND JUNCTION CO
81501-6132
US

IV. Provider business mailing address

751 HORIZON CT SUITE 259
GRAND JUNCTION CO
81506-8733
US

V. Phone/Fax

Practice location:
  • Phone: 970-244-2442
  • Fax: 970-244-7008
Mailing address:
  • Phone: 970-257-1786
  • Fax: 970-257-0035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number36547
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: