Provider Demographics
NPI:1053360016
Name:DELLA ROCCA, GREGORY JOHN (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:JOHN
Last Name:DELLA ROCCA
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:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:ONE HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212
Practice Address - Country:US
Practice Address - Phone:573-882-2663
Practice Address - Fax:573-882-0569
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005011132207X00000X, 207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO199295OtherBLUE SHIELD/BLUE CROSS
MO207416603Medicaid
MO705082OtherHEALTHLINK
MOP00433363Medicare PIN
MO207416603Medicaid
MO913645236Medicare PIN
MO199295OtherBLUE SHIELD/BLUE CROSS
I02679Medicare UPIN