MEDICARE: DR. THOMAS 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	207Q00000X	Family Medicine Physician	MD 17577	TN

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891798575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS ROGERS MD

Provider Business Mailing Address
First Line	:	1325 E CENTER ST
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37664-2444
Country	:	US
Telephone Number	:	423-245-2078
Fax Number	:	423-245-2078

Provider Business Practice Location Address
First Line	:	1325 E CENTER ST
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37664-2444
Country	:	US
Telephone Number	:	423-245-2078
Fax Number	:	423-245-2078

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	02/20/2017

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