Healthcare Provider Details

I. General information

NPI: 1740204676
Provider Name (Legal Business Name): GINGER ROGERS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 VETERANS AVE
BILOXI MS
39531-2410
US

IV. Provider business mailing address

1324 BEACH BLVD
BILOXI MS
39530-3527
US

V. Phone/Fax

Practice location:
  • Phone: 228-523-5000
  • Fax: 228-523-4342
Mailing address:
  • Phone: 228-341-7574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number042411
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: