Provider Demographics
NPI:1184710170
Name:ROCKETT, TODD
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:
Last Name:ROCKETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E CEDAR TREE LN
Mailing Address - Street 2:
Mailing Address - City:HARTSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:65039-9456
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 SAINT MARYS PLZ
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-1602
Practice Address - Country:US
Practice Address - Phone:573-761-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO114590207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOG68320Medicare UPIN