Provider Demographics
NPI:1679884894
Name:ROCK, COLIN MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:COLIN
Middle Name:MATTHEW
Last Name:ROCK
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 1:11311 BRIDGEPORT WAY SW STE 100
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3096
Mailing Address - Country:US
Mailing Address - Phone:253-985-2949
Mailing Address - Fax:253-985-2948
Practice Address - Street 1:11311 BRIDGEPORT WAY SW STE 100
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3096
Practice Address - Country:US
Practice Address - Phone:253-985-2949
Practice Address - Fax:253-985-2948
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61137848207LP2900X
NV15749207LP2900X, 207LP2900X
IL125-058612282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1679884894Medicaid
WA2180630Medicaid