Provider Demographics
NPI:1720070873
Name:ROCKOVE, SHAMMAI (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAMMAI
Middle Name:
Last Name:ROCKOVE
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 1:24076 SE STARK ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-3373
Mailing Address - Country:US
Mailing Address - Phone:503-492-6510
Mailing Address - Fax:503-492-6502
Practice Address - Street 1:24076 SE STARK ST
Practice Address - Street 2:SUITE 310
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3373
Practice Address - Country:US
Practice Address - Phone:503-492-6510
Practice Address - Fax:503-492-6502
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19455208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR0000BLBXFMedicare ID - Type Unspecified
ORG28113Medicare UPIN