Provider Demographics
NPI:1407854037
Name:BRUBAKER, ROCKNE L (MD)
Entity Type:Individual
Prefix:DR
First Name:ROCKNE
Middle Name:L
Last Name:BRUBAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2200 JEFFERSON AVE
Mailing Address - Street 2:5TH FLOOR MERCY PHO/CVO
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-7101
Mailing Address - Country:US
Mailing Address - Phone:419-251-9830
Mailing Address - Fax:419-251-1826
Practice Address - Street 1:225 MEDICAL CENTER DRIVE
Practice Address - Street 2:SUITE 303
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7934
Practice Address - Country:US
Practice Address - Phone:270-444-4222
Practice Address - Fax:270-444-4223
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY49842207Y00000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036074620Medicaid
KY7100433490Medicaid
ILL86172Medicare PIN
IL036074620Medicaid
KY7100433490Medicaid
ILC38823Medicare UPIN
KYK222940Medicare PIN