Healthcare Provider Details

I. General information

NPI: 1699833475
Provider Name (Legal Business Name): STEPHEN J. RODGERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 AUGUSTINE CUT OFF SUITE 14
WILMINGTON DE
19803-4415
US

IV. Provider business mailing address

1701 AUGUSTINE CUT OFF SUITE 14
WILMINGTON DE
19803-4415
US

V. Phone/Fax

Practice location:
  • Phone: 302-421-9111
  • Fax:
Mailing address:
  • Phone: 302-421-9111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberC1-0003358
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: