Provider Demographics
NPI:1295752129
Name:ROCHAT, DERALD W (MD)
Entity type:Individual
Prefix:DR
First Name:DERALD
Middle Name:W
Last Name:ROCHAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 FOWLER WAY STE C
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-5701
Mailing Address - Country:US
Mailing Address - Phone:916-676-1450
Mailing Address - Fax:916-676-1447
Practice Address - Street 1:1008 FOWLER WAY
Practice Address - Street 2:SUITE C
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5701
Practice Address - Country:US
Practice Address - Phone:530-622-1283
Practice Address - Fax:530-622-0283
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG25083207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G250830Medicaid
CA00G250831Medicare ID - Type Unspecified
CA00G250830Medicaid