Provider Demographics
NPI:1083848998
Name:JAMES C. ROCKWELL MD LLC
Entity Type:Organization
Organization Name:JAMES C. ROCKWELL MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROCKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-228-5228
Mailing Address - Street 1:PO BOX 50150
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98015-0150
Mailing Address - Country:US
Mailing Address - Phone:425-228-5228
Mailing Address - Fax:425-228-5733
Practice Address - Street 1:130 CARLANNA LAKE RD
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-5611
Practice Address - Country:US
Practice Address - Phone:907-247-1515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-06
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2782207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD27823Medicaid
AKK162322Medicare PIN