Provider Demographics
NPI:1285846774
Name:DEBRA E RODGERS MD PA
Entity Type:Organization
Organization Name:DEBRA E RODGERS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:E
Authorized Official - Last Name:RODGERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-956-7805
Mailing Address - Street 1:175 OLYMPIA FLDS
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-2510
Mailing Address - Country:US
Mailing Address - Phone:601-956-7805
Mailing Address - Fax:601-056-7805
Practice Address - Street 1:175 OLYMPIA FLDS
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-2510
Practice Address - Country:US
Practice Address - Phone:601-956-7805
Practice Address - Fax:601-956-7805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS080392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00019408Medicaid
MS426961629OtherMS BLUE CROSS
MS426961629OtherMS BLUE CROSS
MS262948455Medicare ID - Type UnspecifiedMEDICARE PROVIDER#