Provider Demographics
NPI:1629312525
Name:ROGERS, I DAVID (MD)
Entity Type:Individual
Prefix:MISS
First Name:I
Middle Name:DAVID
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:PO BOX 21847
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71903-1847
Mailing Address - Country:US
Mailing Address - Phone:501-525-8646
Mailing Address - Fax:501-525-0565
Practice Address - Street 1:1600 HIGHWAY 290
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-9760
Practice Address - Country:US
Practice Address - Phone:501-525-8646
Practice Address - Fax:501-525-0565
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-4901207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine