Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 2021033127 | MO |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 67441 | MN |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 73263 | WI |
NPI | 1053706689 |
---|---|
Provider Name | Thomas Rogers III |
First Address | Ozark, MO 65721-8807 |
Second Address | Ozark, MO 65721-8807 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2015 |
Last Update Date | 09/09/2021 |