Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 2188 | TN |
NPI | 1083700389 |
---|---|
Provider Name | Mr. William Eugene Rogers |
First Address | Knoxville, TN 37922-2337 |
Second Address | Knoxville, TN 37922-2337 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 08/07/2007 |