Healthcare Provider Details

I. General information

NPI: 1194054247
Provider Name (Legal Business Name): LEWIS B ROCK III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DR. SANDY ROCK

II. Dates (important events)

Enumeration Date: 12/21/2009
Last Update Date: 12/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2375 30TH AVE NE
ISSAQUAH WA
98029-3618
US

IV. Provider business mailing address

2375 30TH AVE NE
ISSAQUAH WA
98029-3618
US

V. Phone/Fax

Practice location:
  • Phone: 425-260-4051
  • Fax:
Mailing address:
  • Phone: 425-260-4051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberMD00027081
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: