Provider Demographics
NPI:1881639300
Name:ROCKMAN, BRYCE LEON (CRNA)
Entity Type:Individual
Prefix:MR
First Name:BRYCE
Middle Name:LEON
Last Name:ROCKMAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:MR
Other - First Name:BRYCE
Other - Middle Name:LEON
Other - Last Name:ROCKMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:4028 MEREDITH DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36109-2343
Mailing Address - Country:US
Mailing Address - Phone:334-549-2904
Mailing Address - Fax:
Practice Address - Street 1:4028 MEREDITH DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36109-2343
Practice Address - Country:US
Practice Address - Phone:334-549-2904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1032540367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALS09906Medicare UPIN
AL99183Medicare ID - Type Unspecified