Provider Demographics
NPI:1598924573
Name:ROCK-WILLOUGHBY, JAYME L (DO)
Entity Type:Individual
Prefix:DR
First Name:JAYME
Middle Name:L
Last Name:ROCK-WILLOUGHBY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30 GARDEN CT STE B
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-5302
Mailing Address - Country:US
Mailing Address - Phone:831-647-1123
Mailing Address - Fax:831-886-3647
Practice Address - Street 1:30 GARDEN CT STE B
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5302
Practice Address - Country:US
Practice Address - Phone:831-647-1123
Practice Address - Fax:831-886-3647
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18263207UN0901X, 207RC0000X
OH34.009647207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2966634Medicaid
OH4267851Medicare PIN