Provider Demographics
NPI:1285887067
Name:ROGERS, WILLIAM EVERED (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:EVERED
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 1:7076 CORPORATE WAY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4281
Mailing Address - Country:US
Mailing Address - Phone:937-434-0555
Mailing Address - Fax:937-434-7413
Practice Address - Street 1:7076 CORPORATE WAY
Practice Address - Street 2:SUITE 220
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4281
Practice Address - Country:US
Practice Address - Phone:937-434-0555
Practice Address - Fax:937-434-7413
Is Sole Proprietor?:No
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35041421208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRO0505922Medicare PIN