Provider Demographics
NPI:1538112495
Name:ROGERS, KARL MALONE (MD)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:MALONE
Last Name:ROGERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 HAYES ST
Mailing Address - Street 2:SUITE 720
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2646
Mailing Address - Country:US
Mailing Address - Phone:615-284-2310
Mailing Address - Fax:615-284-2385
Practice Address - Street 1:2004 HAYES ST
Practice Address - Street 2:SUITE 720
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2646
Practice Address - Country:US
Practice Address - Phone:615-284-2310
Practice Address - Fax:615-284-2385
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD18887207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN900002522OtherRAILROAD MEDICARE #
TN3048819Medicaid
TN3113880OtherBCBS OF TN IND PROVIDER #
TN3048819Medicare PIN
TN3048819Medicaid