=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629312525
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | I DAVID ROGERS MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2012
-----------------------------------------------------
Last Update Date | 11/15/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1600 HIGHWAY 290
-----------------------------------------------------
City | HOT SPRINGS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71913-9760
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-525-8646
-----------------------------------------------------
Fax | 501-525-0565
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 21847
-----------------------------------------------------
City | HOT SPRINGS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71903-1847
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-525-8646
-----------------------------------------------------
Fax | 501-525-0565
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | C-4901
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------