Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | 2083 | TN |
NPI | 1043408578 |
---|---|
Provider Name | Dr. Mailien Reed Rogers |
First Address | Mountain Home, TN 37684 |
Second Address | Johnson City, TN 37601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2007 |
Last Update Date | 09/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q055396 | (05) | TN |