Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 16658 | NE |
N | 207VX0000X | Obstetrician | 16658 | NE |
NPI | 1154405926 |
---|---|
Provider Name | Bradley D Rodgers |
First Address | Kearney, NE 68848 |
Second Address | Kearney, NE 68845 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04023 | BCBS (01) | |
47064194508 | (05) | NE |
B68060 | (02) |