1306818190 NPI number — JEFFREY J ROCCO MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306818190 NPI number — JEFFREY J ROCCO MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

ROCCO

Provider First Name:

JEFFREY

Provider Middle Name:

J

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1306818190

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

09/12/2022

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

5782 ADAMS AVE PKWY

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

OGDEN

Provider Business Mailing Address State Name:

UT

Provider Business Mailing Address Postal Code:

84405-6947

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

801-917-8020

Provider Business Mailing Address Fax Number:

801-917-8001

Provider First Line Business Practice Location Address:

5782 ADAMS AVENUE PARKWAY

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

WASHINGTON TERRACE

Provider Business Practice Location Address State Name:

UT

Provider Business Practice Location Address Postal Code:

84405

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

801-917-8000

Provider Business Practice Location Address Fax Number:

801-917-8001

Provider Enumeration Date:

02/06/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207X00000X , with the licence number:  60233511205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 005587209 . This is a "MEDICARE PART B" identifier . This identifiers is of the category "OTHER".
• Identifier: 870680455011 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
• Identifier: H65675 . This is a "PUBLIC EMPLOYEES" identifier . This identifiers is of the category "OTHER".
• Identifier: 60233511200001 . This is a "HEALTHWISE" identifier . This identifiers is of the category "OTHER".
• Identifier: 60233511200001 . This is a "BC OF WYO" identifier . This identifiers is of the category "OTHER".
• Identifier: 60233511200001 . This is a "VALUECARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 60233511200001 . This is a "BCBS OF OTHER STATE" identifier . This identifiers is of the category "OTHER".
• Identifier: 60233511200001 . This is a "FED BCBS" identifier . This identifiers is of the category "OTHER".
• Identifier: 000055872 . This is a "MEDICARE PART B" identifier . This identifiers is of the category "OTHER".
• Identifier: D6480 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
• Identifier: 60233511200001 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
• Identifier: 60233511200001 . This is a "BCBS MEDADVANTAGE" identifier . This identifiers is of the category "OTHER".
• Identifier: 86192 . This is a "PUBLIC EMPLOYEES" identifier . This identifiers is of the category "OTHER".