Healthcare Provider Details

I. General information

NPI: 1073530812
Provider Name (Legal Business Name): BARRY MICHAEL ROCKLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3509 FRENCH PARK DR STE D
EDMOND OK
73034-7296
US

IV. Provider business mailing address

3509 FRENCH PARK DR STE D
EDMOND OK
73034-7296
US

V. Phone/Fax

Practice location:
  • Phone: 405-715-4500
  • Fax:
Mailing address:
  • Phone: 405-715-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number13073
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberE-0491
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number04-24523
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: