Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207ND0101X | MOHS-Micrographic Surgeon | 27131 | SC |
Y | 207NS0135X | Procedural Dermatology | 27131 | SC |
NPI | 1215989587 |
---|---|
Provider Name | Robert Marshall Rogers |
First Address | Greenville, SC 29605-4019 |
Second Address | Greenville, SC 29605-4019 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 22/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
271315 | (05) | SC |
AA07788961 | MEDICARE PTAN (01) | SC |
I25511 | (02) | SC |