Provider Demographics
NPI:1770638413
Name:GIPSON, ROCKY JAMES (HS)
Entity Type:Individual
Prefix:MR
First Name:ROCKY
Middle Name:JAMES
Last Name:GIPSON
Suffix:
Gender:M
Credentials:HS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 SPRING VALLEY DR S
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36693-4358
Mailing Address - Country:US
Mailing Address - Phone:251-610-2142
Mailing Address - Fax:
Practice Address - Street 1:USCGC BERTHOLF (WMSL-750)
Practice Address - Street 2:COAST GUARD ISLAND
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501
Practice Address - Country:US
Practice Address - Phone:251-610-2142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman