Provider Demographics
NPI:1689633760
Name:RODGERS, KENNETH FRANKLIN (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:FRANKLIN
Last Name:RODGERS
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 1:1707 LINWOOD DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-5364
Mailing Address - Country:US
Mailing Address - Phone:870-236-2202
Mailing Address - Fax:870-236-8428
Practice Address - Street 1:1707 LINWOOD DR
Practice Address - Street 2:SUITE A
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-5364
Practice Address - Country:US
Practice Address - Phone:870-236-2202
Practice Address - Fax:870-236-8428
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-7528207P00000X, 208600000X
ARC7528207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR118700001Medicaid
MO209217702Medicaid
MO209217702Medicaid
MO209217702Medicaid