Provider Demographics
NPI:1215434261
Name:ROCK, LEAH BURCH (MD)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:BURCH
Last Name:ROCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:BRIANNE
Other - Last Name:BURCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-579-5463
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:201A BAY AVE
Practice Address - Street 2:
Practice Address - City:RICHTON
Practice Address - State:MS
Practice Address - Zip Code:39476-9671
Practice Address - Country:US
Practice Address - Phone:601-583-1559
Practice Address - Fax:601-579-5240
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS29171207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04921851Medicaid