Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | M9667 | ID |
NPI | 1427151539 |
---|---|
Provider Name | Beth S Rogers |
First Address | Meridian, ID 83642-3295 |
Second Address | Meridian, ID 83642-6318 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2006 |
Last Update Date | 04/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H53924 | (02) | ID |