Healthcare Provider Details

I. General information

NPI: 1740740448
Provider Name (Legal Business Name): ROCK PAUL VOMER II DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3904 OLEANDER DR
WILMINGTON NC
28403-6717
US

IV. Provider business mailing address

10900 WORLD TRADE BLVD
RALEIGH NC
27617-4202
US

V. Phone/Fax

Practice location:
  • Phone: 910-530-1874
  • Fax:
Mailing address:
  • Phone: 919-237-1337
  • Fax: 919-237-1625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number202302571
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: