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General NPI Number Information
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NPI Number | 1558472647
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Entity Type | Individual
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Provider Name | PETER T ROGERS M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5TH & ROOSEVELT
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City | HINES
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State | IL
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Zip | 60141
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Country | US
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Telephone | 708-202-2169
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Fax |
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Provider Business Mailing Address
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Address Line | 13215 W HUNT MASTER LN
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City | LEMONT
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State | IL
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Zip | 60439-8169
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Country | US
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Telephone | 630-408-8193
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 036-93221
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License Number State | IL
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