Provider Demographics
NPI:1801962121
Name:ROCKWOOD, JASON W (DPM)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:W
Last Name:ROCKWOOD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1844 W RIVER BIRCH RD
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:UT
Mailing Address - Zip Code:84664-5669
Mailing Address - Country:US
Mailing Address - Phone:505-660-4899
Mailing Address - Fax:
Practice Address - Street 1:3152 N UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-4745
Practice Address - Country:US
Practice Address - Phone:801-356-0233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM323213E00000X
IDP-264213E00000X
UT9704032-0501213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000085112Medicare ID - Type Unspecified
V08163Medicare UPIN