Healthcare Provider Details

I. General information

NPI: 1316974389
Provider Name (Legal Business Name): MARC STEPHEN ROCKLIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4735 E 91ST ST #200
TULSA OK
74137-2804
US

IV. Provider business mailing address

6600 S YALE AVE SUITE 1400
TULSA OK
74136-3347
US

V. Phone/Fax

Practice location:
  • Phone: 918-794-4788
  • Fax: 918-794-4789
Mailing address:
  • Phone: 918-488-6001
  • Fax: 918-488-6010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number17406
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: