1841032547 NPI number — DEBORAH RICHARDSON ROCK PROSTHETIC PROVIDER

Table of content: DEBORAH RICHARDSON ROCK PROSTHETIC PROVIDER (NPI 1841032547)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841032547 NPI number — DEBORAH RICHARDSON ROCK PROSTHETIC PROVIDER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROCK
Provider First Name:
DEBORAH
Provider Middle Name:
RICHARDSON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PROSTHETIC PROVIDER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROCK
Provider Other First Name:
DEBORAH
Provider Other Middle Name:
R
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
SPECIALIST
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1841032547
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1702 CIRCLE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANSFIELD
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71052-3604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-461-6443
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
531 LOUISE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANSFIELD
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71052-3604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-461-6443
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/12/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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