Provider Demographics
NPI:1194054247
Name:ROCK, LEWIS B III (MD)
Entity type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:B
Last Name:ROCK
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SANDY
Other - Middle Name:
Other - Last Name:ROCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2375 30TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-3618
Mailing Address - Country:US
Mailing Address - Phone:425-260-4051
Mailing Address - Fax:
Practice Address - Street 1:2375 30TH AVE NE
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-3618
Practice Address - Country:US
Practice Address - Phone:425-260-4051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-21
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000270812083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine