Provider Demographics
NPI:1932364049
Name:ROGERS, AMY L (DO)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:L
Last Name:ROGERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-2508
Mailing Address - Country:US
Mailing Address - Phone:931-815-5437
Mailing Address - Fax:931-507-5440
Practice Address - Street 1:236 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-2508
Practice Address - Country:US
Practice Address - Phone:931-815-5437
Practice Address - Fax:931-507-5440
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2254208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics