Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 01066844 | IN |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 35.084101 | OH |
NPI | 1013916345 |
---|---|
Provider Name | Derrick Thomas Rogers |
First Address | Muncie, IN 47303-4988 |
Second Address | Muncie, IN 47303-3421 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 19/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200949350 | (05) | IN |
2488259 | (05) | OH |
I14797 | (02) | IN |