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NPI Code Detail

MEDICARE: MR. SEAN DALE ROCKETT PA-C

MEDICARE: MR. SEAN DALE ROCKETT PA-C
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
1363A00000XPhysician AssistantPA05097TX
2363AM0700XMedical Physician AssistantPA05097TX
3363A00000XPhysician AssistantPA.0005304CO

Other Identifiers

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

General Provider Information

NPI Number : 1215093539
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. SEAN DALE ROCKETT PA-C
Provider Business Mailing Address
First Line : 2860 S CIRCLE DR STE 109
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80906-4195
Country : US
Telephone Number : 888-374-5066
Fax Number : 719-623-0165
Provider Business Practice Location Address
First Line : 3351 EASTBROOK DR STE 200
Second Line :
City : FORT COLLINS
State : CO
Zip : 80525-5744
Country : US
Telephone Number : 888-374-5066
Fax Number : 719-623-0165
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2006
Last Update Date : 01/18/2024

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Directions to “ MR. SEAN DALE ROCKETT PA-C” Practice Location

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