Provider Demographics
NPI:1891798575
Name:ROGERS, THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
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 1:1325 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-2444
Mailing Address - Country:US
Mailing Address - Phone:423-245-2078
Mailing Address - Fax:423-245-2078
Practice Address - Street 1:1325 E CENTER ST
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-2444
Practice Address - Country:US
Practice Address - Phone:423-245-2078
Practice Address - Fax:423-245-2078
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD 17577207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5637180Medicaid
TN3026843Medicaid
A99067Medicare UPIN
TN103I086169Medicare UPIN
TN3026843Medicaid