Healthcare Provider Details

I. General information

NPI: 1245238385
Provider Name (Legal Business Name): STEPHEN J ROGERS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 BALD HILL RD STE 503
WARWICK RI
02886-1617
US

IV. Provider business mailing address

400 BALD HILL RD SUITE 503
WARWICK RI
02886-1617
US

V. Phone/Fax

Practice location:
  • Phone: 401-738-7750
  • Fax: 401-738-9750
Mailing address:
  • Phone: 401-738-7750
  • Fax: 401-738-9750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberDPM00279
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberDPM2323
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: