Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 01052391A | IN |
N | 111NI0900X | Internist | 01052391A | IN |
Y | 207RA0201X | Internist - Allergy & Immunology | 01052391A | IN |
NPI | 1265437255 |
---|---|
Provider Name | Dr. Geoffrey A. Rogers |
First Address | Elkhart, IN 46515-2968 |
Second Address | Elkhart, IN 46514-2066 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2005 |
Last Update Date | 07/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200315050A | (05) | IN |
C37043 | (02) | IN |