Provider Demographics
NPI:1336109420
Name:ROCKWELL, JEFFREY J (MD)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:J
Last Name:ROCKWELL
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 913001
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80291-3001
Mailing Address - Country:US
Mailing Address - Phone:817-334-0530
Mailing Address - Fax:817-877-0350
Practice Address - Street 1:320 BEARD CREEK ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632-6426
Practice Address - Country:US
Practice Address - Phone:970-569-7400
Practice Address - Fax:817-877-0350
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1027207L00000X
CODR0060456207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103440701Medicaid
TX103440701Medicaid
TX82X398Medicare PIN