Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | A130552 | CA |
Y | 2080P0203X | Pediatric Critical Care Doctor | A130552 | CA |
NPI | 1306145982 |
---|---|
Provider Name | Timothy M Rogers |
First Address | Newtown, PA 18940-2003 |
Second Address | San Francisco, CA 94143-2204 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2011 |
Last Update Date | 11/02/2022 |