MEDICARE: TED B ROGERS MD

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	207X00000X	Orthopaedic Surgery Physician	35858	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000341623	OTHER	KY	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2446228000	OTHER	KY	PASSPORT ADVANTAGE
4	50004884	OTHER	KY	PASSPORT

General Provider Information

NPI Number	:	1336142025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TED B ROGERS MD

Provider Business Mailing Address
First Line	:	908 WALLACE AVE
Second Line	:
City	:	LEITCHFIELD
State	:	KY
Zip	:	42754-1479
Country	:	US
Telephone Number	:	270-259-0124
Fax Number	:	270-230-0157

Provider Business Practice Location Address
First Line	:	908 WALLACE AVE
Second Line	:
City	:	LEITCHFIELD
State	:	KY
Zip	:	42754
Country	:	US
Telephone Number	:	270-230-0124
Fax Number	:	270-230-0157

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	03/12/2020

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