Provider Demographics
NPI:1326157108
Name:FROCK, JAMES T (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:T
Last Name:FROCK
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 642117
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-8117
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7710 MERCY ROAD
Practice Address - Street 2:SUITE 500
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68132
Practice Address - Country:US
Practice Address - Phone:402-343-8650
Practice Address - Fax:402-343-8655
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE16833207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1326157108Medicare UPIN
IA41959Medicare PIN
NE390005304Medicare PIN
NE086032Medicare PIN