Provider Demographics
NPI:1003823253
Name:ROCKLEY, PAUL F (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:F
Last Name:ROCKLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:17101 NE 19TH AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-3159
Mailing Address - Country:US
Mailing Address - Phone:305-940-7766
Mailing Address - Fax:305-940-4617
Practice Address - Street 1:17101 NE 19TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-3159
Practice Address - Country:US
Practice Address - Phone:305-940-7766
Practice Address - Fax:305-940-4617
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0056806207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264506800Medicaid
FLK1840Medicare ID - Type Unspecified
FL264506800Medicaid