Provider Demographics
NPI:1053303735
Name:ROCK, PETER T (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:T
Last Name:ROCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 495
Mailing Address - Street 2:
Mailing Address - City:EAST BERNSTADT
Mailing Address - State:KY
Mailing Address - Zip Code:40729-0495
Mailing Address - Country:US
Mailing Address - Phone:606-843-6195
Mailing Address - Fax:606-843-6222
Practice Address - Street 1:2645 N LAUREL RD
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-9075
Practice Address - Country:US
Practice Address - Phone:606-843-6195
Practice Address - Fax:606-843-6222
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23757207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000047128OtherBCBS-LCMC
KY000000107907OtherBCBS-AMC
KY64237571Medicaid
KY000000068618OtherBCBS-EBMC
KY000000107860OtherBCBS-BSMC
KYB87393Medicare UPIN
KY000000047128OtherBCBS-LCMC
KY0230802Medicare PIN
KY0076903Medicare PIN