Provider Demographics
NPI:1336333178
Name:PAUL F. ROCKLEY M.D. P.A
Entity Type:Organization
Organization Name:PAUL F. ROCKLEY M.D. P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:F
Authorized Official - Last Name:ROCKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-940-7766
Mailing Address - Street 1:17101 NE 19TH AVE
Mailing Address - Street 2:STE 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:STE 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1840Medicare PIN
FLG57269Medicare UPIN