Provider Demographics
NPI:1518907690
Name:ROGERS, MARILYN JO (MD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:JO
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:105 RIVERPOINT RD
Mailing Address - Street 2:
Mailing Address - City:SIGNAL MOUNTAIN
Mailing Address - State:TN
Mailing Address - Zip Code:37377-2237
Mailing Address - Country:US
Mailing Address - Phone:423-886-5986
Mailing Address - Fax:727-507-3618
Practice Address - Street 1:975 E 3RD ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2103
Practice Address - Country:US
Practice Address - Phone:423-778-7296
Practice Address - Fax:423-778-8068
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN10019207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B04013Medicare UPIN