Healthcare Provider Details

I. General information

NPI: 1053706689
Provider Name (Legal Business Name): THOMAS ROGERS III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 E RIVER BLUFF BLVD
OZARK MO
65721-8807
US

IV. Provider business mailing address

3050 E RIVER BLUFF BLVD
OZARK MO
65721-8807
US

V. Phone/Fax

Practice location:
  • Phone: 178-205-6104
  • Fax:
Mailing address:
  • Phone: 178-205-6104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2021033127
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number73263
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number67441
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number2021033127
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: