Provider Demographics
NPI:1316974389
Name:ROCKLIN, MARC STEPHEN (MD)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:STEPHEN
Last Name:ROCKLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6600 S YALE AVE
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3347
Mailing Address - Country:US
Mailing Address - Phone:918-488-6001
Mailing Address - Fax:918-488-6010
Practice Address - Street 1:4735 E 91ST ST
Practice Address - Street 2:#200
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-2804
Practice Address - Country:US
Practice Address - Phone:918-794-4788
Practice Address - Fax:918-794-4789
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2014-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK17406208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100029110AMedicaid
OK100029110AMedicaid