Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 20247020 | WI |
NPI | 1235124066 |
---|---|
Provider Name | Dr. John Charles Rogers |
First Address | Milwaukee, WI 53220-1935 |
Second Address | Milwaukee, WI 53220-1935 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2005 |
Last Update Date | 22/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30364700 | (05) | WI |
B56119 | (02) |