Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 49623 | TN |
NPI | 1043463029 |
---|---|
Provider Name | William Bradley Rogers |
First Address | Johnson City, TN 37604-2977 |
Second Address | Johnson City, TN 37604-2977 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2008 |
Last Update Date | 19/06/2013 |