Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | MD10279 | RI |
NPI | 1720198146 |
---|---|
Provider Name | Joseph Lewis Rodgers JR. |
First Address | East Greenwich, RI 02818-1310 |
Second Address | Providence, RI 02905-1522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 31/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D94286 | (02) | RI |