Provider Demographics
NPI:1033228242
Name:RODGERS, GRAYSON K (MD)
Entity Type:Individual
Prefix:DR
First Name:GRAYSON
Middle Name:K
Last Name:RODGERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 10TH AVE S STE 502
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1250
Mailing Address - Country:US
Mailing Address - Phone:205-933-2951
Mailing Address - Fax:205-933-5893
Practice Address - Street 1:2700 10TH AVE S STE 502
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1250
Practice Address - Country:US
Practice Address - Phone:205-933-2951
Practice Address - Fax:205-933-5893
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00016561207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000060123Medicare ID - Type Unspecified
ALF27962Medicare UPIN