Healthcare Provider Details

I. General information

NPI: 1336333178
Provider Name (Legal Business Name): PAUL F. ROCKLEY M.D. P.A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2007
Last Update Date: 09/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17101 NE 19TH AVE STE 101
NORTH MIAMI BEACH FL
33162-3159
US

IV. Provider business mailing address

17101 NE 19TH AVE STE 101
NORTH MIAMI BEACH FL
33162-3159
US

V. Phone/Fax

Practice location:
  • Phone: 305-940-7766
  • Fax: 305-940-4617
Mailing address:
  • Phone: 305-940-7766
  • Fax: 305-940-4617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PAUL F ROCKLEY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 305-940-7766