Healthcare Provider Details

I. General information

NPI: 1811953474
Provider Name (Legal Business Name): ROBERT MARK RODGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3787 SHIPYARD BLVD
WILMINGTON NC
28403-6148
US

IV. Provider business mailing address

3787 SHIPYARD BLVD
WILMINGTON NC
28403-6148
US

V. Phone/Fax

Practice location:
  • Phone: 910-332-3800
  • Fax: 910-763-8804
Mailing address:
  • Phone: 910-332-3800
  • Fax: 910-763-8804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number33885
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number33885
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: