Provider Demographics
NPI:1730157918
Name:JEAN-GUILLAUME, ROCK H (DO)
Entity type:Individual
Prefix:
First Name:ROCK
Middle Name:H
Last Name:JEAN-GUILLAUME
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SHREWSBURY ST STE D
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01520-1960
Mailing Address - Country:US
Mailing Address - Phone:508-829-3810
Mailing Address - Fax:508-829-3815
Practice Address - Street 1:5 SHREWSBURY ST STE D
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:MA
Practice Address - Zip Code:01520
Practice Address - Country:US
Practice Address - Phone:508-829-3800
Practice Address - Fax:508-829-3802
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2020-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA215241207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110006102AMedicaid
MAJ25229OtherBC/BS
MAJ25229OtherBC/BS
MAH65146Medicare UPIN