Provider Demographics
NPI:1568457497
Name:ROGERS, ROLLAND R III (DO)
Entity Type:Individual
Prefix:MR
First Name:ROLLAND
Middle Name:R
Last Name:ROGERS
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 BENEDICT AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857-2715
Mailing Address - Country:US
Mailing Address - Phone:419-668-1101
Mailing Address - Fax:419-668-1191
Practice Address - Street 1:257 BENEDICT AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-2715
Practice Address - Country:US
Practice Address - Phone:419-668-1101
Practice Address - Fax:419-668-1191
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007775R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRO4111241Medicare ID - Type Unspecified
OHH88522Medicare UPIN