Healthcare Provider Details

I. General information

NPI: 1609870542
Provider Name (Legal Business Name): ROBERT ROGERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 01/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 W STONE DR SUITE 4A
KINGSPORT TN
37660-3256
US

IV. Provider business mailing address

PO BOX 9
KINGSPORT TN
37662-0009
US

V. Phone/Fax

Practice location:
  • Phone: 423-392-6265
  • Fax: 423-392-6272
Mailing address:
  • Phone: 423-857-2066
  • Fax: 423-857-2070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD 23700
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: