Provider Demographics
NPI:1699833475
Name:RODGERS, STEPHEN J (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
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 1:1701 AUGUSTINE CUT OFF
Mailing Address - Street 2:SUITE 14
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-4415
Mailing Address - Country:US
Mailing Address - Phone:302-421-9111
Mailing Address - Fax:
Practice Address - Street 1:1701 AUGUSTINE CUT OFF
Practice Address - Street 2:SUITE 14
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-4415
Practice Address - Country:US
Practice Address - Phone:302-421-9111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-00033582083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine