Provider Demographics
NPI:1225175623
Name:ROGERS, THOMAS L (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:L
Last Name:ROGERS
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:1085 S LINDEN RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3421
Mailing Address - Country:US
Mailing Address - Phone:810-732-3240
Mailing Address - Fax:810-230-0280
Practice Address - Street 1:1 HURLEY PLZ
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-5902
Practice Address - Country:US
Practice Address - Phone:810-762-6675
Practice Address - Fax:810-762-6341
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601001606363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
R68593Medicare UPIN