Provider Demographics
NPI:1356391791
Name:ROCK, DAVID T (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:T
Last Name:ROCK
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 1:9071 BONITA BEACH RD SE STE 1389
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-4213
Mailing Address - Country:US
Mailing Address - Phone:724-859-8783
Mailing Address - Fax:239-359-6480
Practice Address - Street 1:24040 S TAMIAMI TRL STE 202
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-7040
Practice Address - Country:US
Practice Address - Phone:239-758-7465
Practice Address - Fax:239-799-2330
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME110898208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003989600Medicaid
FL14FQ8OtherBCBS FL
FLP995031OtherFREEDOM HEALTH
FL003989600Medicaid
FL8812030OtherCIGNA
FL14FQ8OtherBCBS FL
FL349343OtherAVMED
FL873196OtherWELLCARE
NC133JUOtherBCBS
FL5430524OtherAETNA
FL225852OtherUNIVERSAL HEALTHCARE
FL349343OtherAVMED
FLP936577OtherOPTIMUM
NCG64216Medicare UPIN