MEDICARE: JAMES C. ROCKWELL MD LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	2782	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083848998
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES C. ROCKWELL MD LLC

Provider Business Mailing Address
First Line	:	PO BOX 50150
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98015-0150
Country	:	US
Telephone Number	:	425-228-5228
Fax Number	:	425-228-5733

Provider Business Practice Location Address
First Line	:	130 CARLANNA LAKE RD
Second Line	:
City	:	KETCHIKAN
State	:	AK
Zip	:	99901-5611
Country	:	US
Telephone Number	:	907-247-1515
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES C. ROCKWELL
Credential	:	MD
Telephone Number	:	425-228-5228

Provider Enumeration Date	:	05/06/2009
Last Update Date	:	06/18/2009

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