Provider Demographics
NPI:1730131210
Name:ROCCONI, RODNEY P (MD)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:P
Last Name:ROCCONI
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 1:504 CLINTON CENTER DR STE 4300
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-5610
Mailing Address - Country:US
Mailing Address - Phone:601-815-2005
Mailing Address - Fax:601-815-0434
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-815-2005
Practice Address - Fax:601-815-0434
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL24356207VX0201X
MS31654207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009959195Medicaid
AL051523451OtherBLUE CROSS
AL009932801Medicaid
AL009959175Medicaid
AL051524134OtherBLUE CROSS
AL009959185Medicaid
AL051523452OtherBLUE CROSS
MS08359785Medicaid
AL009959165Medicaid
AL051523449OtherBLUE CROSS
AL051523450OtherBLUE CROSS
AL51540819OtherBCBS
AL009943213Medicaid
AL009969165Medicaid
AL051530430OtherBLUE CROSS
AL51540819OtherBCBS
AL009969165Medicaid