Provider Demographics
NPI:1891767463
Name:KEARNEY, ROCHFORT WYNN JR (MD)
Entity Type:Individual
Prefix:MR
First Name:ROCHFORT
Middle Name:WYNN
Last Name:KEARNEY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 PREMIER DR
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-6076
Mailing Address - Country:US
Mailing Address - Phone:507-386-6600
Mailing Address - Fax:507-625-5971
Practice Address - Street 1:1431 PREMIER DR
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-6076
Practice Address - Country:US
Practice Address - Phone:507-386-6600
Practice Address - Fax:507-625-5971
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN18814207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN41349KEOtherBCBS
MN751383600Medicaid
MN0901556OtherMEDICA
MN983181004371OtherPREFERRED ONE
MN410940705H005OtherTRICARE WPS
MN115622C572OtherUCARE
MNHP18794OtherHEALTH PARTNERS
MN115622C572OtherUCARE
MN410940705H005OtherTRICARE WPS
MN983181004371OtherPREFERRED ONE