Provider Demographics
NPI:1649467028
Name:ROCK, KERRYN MORTIMER (MD)
Entity type:Individual
Prefix:
First Name:KERRYN
Middle Name:MORTIMER
Last Name:ROCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 OAK LAWN AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4236
Mailing Address - Country:US
Mailing Address - Phone:214-252-3500
Mailing Address - Fax:
Practice Address - Street 1:3300 OAK LAWN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4236
Practice Address - Country:US
Practice Address - Phone:214-252-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0408207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology