Provider Demographics
NPI:1497723027
Name:ROCK, ALICE (MD)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:ROCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:ROCK
Other - Last Name:KEATON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6431 FANNIN ST
Mailing Address - Street 2:SUITE MSB 5.111
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-5389
Mailing Address - Country:US
Mailing Address - Phone:713-500-6325
Mailing Address - Fax:713-500-0706
Practice Address - Street 1:6431 FANNIN ST.
Practice Address - Street 2:SUITE MSB5.111
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-5389
Practice Address - Country:US
Practice Address - Phone:713-500-6325
Practice Address - Fax:713-500-0706
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI29505-20208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA063644D6XMedicaid