MEDICARE: ALICE ROCK MD

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	208000000X	Pediatrics Physician	29505-20	WI

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	:	1497723027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICE ROCK MD

Provider Business Mailing Address
First Line	:	6431 FANNIN ST
Second Line	:	SUITE MSB 5.111
City	:	HOUSTON
State	:	TX
Zip	:	77030-5389
Country	:	US
Telephone Number	:	713-500-6325
Fax Number	:	713-500-0706

Provider Business Practice Location Address
First Line	:	6431 FANNIN ST.
Second Line	:	SUITE MSB5.111
City	:	HOUSTON
State	:	TX
Zip	:	77030-5389
Country	:	US
Telephone Number	:	713-500-6325
Fax Number	:	713-500-0706

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	04/29/2019

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Directions to “ ALICE ROCK MD” Practice Location

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