Healthcare Provider Details

I. General information

NPI: 1467292029
Provider Name (Legal Business Name): SUNNY JOEL ROKKAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 12/12/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 4TH STREET
LUBBOCK TX
79430
US

IV. Provider business mailing address

TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER, DEPARTMEN 3601 4TH STREET, MAILSTOP 8321
LUBBOCK TX
79430-8321
US

V. Phone/Fax

Practice location:
  • Phone: 806-743-3849
  • Fax:
Mailing address:
  • Phone: 806-743-3849
  • Fax: 806-743-5687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: