Provider Demographics
NPI:1487653952
Name:ROGERS, MARC ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:ANTHONY
Last Name:ROGERS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1101 JACKSON ST SW
Mailing Address - Street 2:
Mailing Address - City:GRAVETTE
Mailing Address - State:AR
Mailing Address - Zip Code:72736-9121
Mailing Address - Country:US
Mailing Address - Phone:479-787-5291
Mailing Address - Fax:479-344-6404
Practice Address - Street 1:1101 JACKSON ST SW
Practice Address - Street 2:
Practice Address - City:GRAVETTE
Practice Address - State:AR
Practice Address - Zip Code:72736-9121
Practice Address - Country:US
Practice Address - Phone:479-787-5291
Practice Address - Fax:479-344-6404
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2023-04-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARC8301208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARG48673Medicare UPIN
AR5K4876968Medicare PIN