Provider Demographics
NPI:1194880351
Name:ROGERS, DELMAR MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:DELMAR
Middle Name:MICHAEL
Last Name:ROGERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:221 TECHNOLOGY PKWY NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1369
Mailing Address - Country:US
Mailing Address - Phone:762-235-1000
Mailing Address - Fax:
Practice Address - Street 1:796 N DIVISION ST NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1404
Practice Address - Country:US
Practice Address - Phone:762-235-3760
Practice Address - Fax:706-232-4131
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0228782086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000223374FMedicaid
GA000223374AMedicaid
E59168Medicare UPIN
GA000223374AMedicaid