Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 2009001623 | MO |
NPI | 1053316513 |
---|---|
Provider Name | Melissa M Rodgers |
First Address | Clinton, MO 64735-8804 |
Second Address | Union, MO 63084 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2005 |
Last Update Date | 23/01/2019 |