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NPI Code Detail

MEDICARE: ALICE ROCK MD

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
1208000000XPediatrics Physician29505-20WI

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 : 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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