Provider Demographics
NPI:1043463029
Name:ROGERS, WILLIAM BRADLEY (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BRADLEY
Last Name:ROGERS
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 1:2340 KNOB CREEK RD
Mailing Address - Street 2:SUITE 720
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2977
Mailing Address - Country:US
Mailing Address - Phone:423-926-6112
Mailing Address - Fax:
Practice Address - Street 1:2340 KNOB CREEK RD
Practice Address - Street 2:SUITE 720
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2977
Practice Address - Country:US
Practice Address - Phone:423-926-6112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN49623208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology