Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 173551 | NY |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 173351 | NY |
NPI | 1528008596 |
---|---|
Provider Name | Dr. Thomas Paul Rodgers |
First Address | Elmira, NY 14901-3230 |
Second Address | Big Flats, NY 14814 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 30/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01067990 | (05) | NY |
1733518 | WORKERS COMP (01) | NY |