Provider Demographics
NPI:1801030903
Name:ROCKINS, KEITH (IDMT)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:ROCKINS
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 MAYNARD ST
Mailing Address - Street 2:307A FLIGHT MEDICINE
Mailing Address - City:POPE AFB
Mailing Address - State:NC
Mailing Address - Zip Code:28308-2321
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:383 MAYNARD ST
Practice Address - Street 2:307A FLIGHT MEDICINE
Practice Address - City:POPE AFB
Practice Address - State:NC
Practice Address - Zip Code:28308-2321
Practice Address - Country:US
Practice Address - Phone:910-394-1328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians