Healthcare Provider Details

I. General information

NPI: 1396918173
Provider Name (Legal Business Name): SPENCER EDMUND RODGERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2008
Last Update Date: 09/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2018 W CLINCH AVE NICU
KNOXVILLE TN
37916-2301
US

IV. Provider business mailing address

1011 HENDERSON LN
KNOXVILLE TN
37922-5208
US

V. Phone/Fax

Practice location:
  • Phone: 865-541-8000
  • Fax:
Mailing address:
  • Phone: 865-919-6568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number47594
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number47594
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: