Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | MD15687 | RI |
NPI | 1063824779 |
---|---|
Provider Name | Ralph Rogers |
First Address | Providence, RI 02903-4626 |
Second Address | Providence, RI 02903-4923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2014 |
Last Update Date | 07/05/2019 |