Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 71625 | GA |
N | 207N00000X | Dermatologist | 85301 | SC |
N | 207N00000X | Dermatologist | Q6096 | TX |
N | 207ND0101X | MOHS-Micrographic Surgeon | 71625 | GA |
N | 207ND0101X | MOHS-Micrographic Surgeon | 85301 | SC |
N | 207ND0101X | MOHS-Micrographic Surgeon | Q6096 | TX |
NPI | 1396065470 |
---|---|
Provider Name | Dr. Ryan Travis Rogers |
First Address | Dublin, GA 31021-2890 |
Second Address | Augusta, GA 30904-4717 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2010 |
Last Update Date | 10/02/2021 |