MEDICARE: ANITA GAYLE ROGERS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	26795	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	26795	OTHER	KY	KY MEDICAL LICENSE NUMBER
3	000000221170	OTHER		ANTHEM PROVIDER ID

General Provider Information

NPI Number	:	1134147499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANITA GAYLE ROGERS M.D.

Provider Business Mailing Address
First Line	:	505 SHOPPERS DR
Second Line	:	SUITE 3
City	:	WINCHESTER
State	:	KY
Zip	:	40391-2808
Country	:	US
Telephone Number	:	859-737-3911
Fax Number	:	859-737-9511

Provider Business Practice Location Address
First Line	:	505 SHOPPERS DR
Second Line	:	SUITE 3
City	:	WINCHESTER
State	:	KY
Zip	:	40391-2808
Country	:	US
Telephone Number	:	859-737-3911
Fax Number	:	859-737-9511

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	07/08/2007

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