Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 24248 | WI |
Y | 208600000X | Surgeon | 24248 | WI |
NPI | 1003893371 |
---|---|
Provider Name | Barry L Rogers |
First Address | Berlin, WI 54923-1243 |
Second Address | Berlin, WI 54923-1243 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2005 |
Last Update Date | 24/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30416700 | (05) | WI |
B5616 | (02) | WI |