MEDICARE: NANCY MOULTRIE ROCKSTROH 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	207Q00000X	Family Medicine Physician	33926	TN
2	207Q00000X	Family Medicine Physician	ME99966	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	080166149	OTHER	TN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	122921	OTHER	TN	MISSISSIPPI MEDT
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	117415	OTHER	TN	BETTER HEALTH
4	3164959	OTHER	TN	BC BS OF TN
6	14449	OTHER	TN	TLC
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659363430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY MOULTRIE ROCKSTROH MD

Provider Business Mailing Address
First Line	:	333 CEDAR RUN DR
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32003-8156
Country	:	US
Telephone Number	:	901-215-8485
Fax Number	:

Provider Business Practice Location Address
First Line	:	JAX-NAS NAVAL HOSPITAL
Second Line	:	2080 CHILD STREET
City	:	JACKSONVILLE
State	:	FL
Zip	:	32214-5000
Country	:	US
Telephone Number	:	904-542-7975
Fax Number	:

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

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	10/30/2008

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