Provider Demographics
NPI:1093265639
Name:RODGERS, HARRY III
Entity Type:Individual
Prefix:MR
First Name:HARRY
Middle Name:
Last Name:RODGERS
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 FRENCH MILL RUN
Mailing Address - Street 2:APT 22
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-3455
Mailing Address - Country:US
Mailing Address - Phone:330-553-4291
Mailing Address - Fax:
Practice Address - Street 1:25 FRENCH MILL RUN
Practice Address - Street 2:APT 22
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-3455
Practice Address - Country:US
Practice Address - Phone:330-553-4291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization