Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | M8251 | ID |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | M8251 | ID |
NPI | 1396763272 |
---|---|
Provider Name | Bret J Rodgers |
First Address | Boise, ID 83713-0997 |
Second Address | Boise, ID 83713-0997 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H26494 | (02) |