Provider Demographics
NPI:1942291067
Name:ROGERS, J. TYLER (MD)
Entity Type:Individual
Prefix:
First Name:J.
Middle Name:TYLER
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:PROF
Other - First Name:J. TYLER
Other - Middle Name:
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:153 W MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-9224
Mailing Address - Country:US
Mailing Address - Phone:614-939-2200
Mailing Address - Fax:614-939-2201
Practice Address - Street 1:153 W MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-9224
Practice Address - Country:US
Practice Address - Phone:614-939-2200
Practice Address - Fax:614-939-2201
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35075846R208000000X
FLME129585208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2233050Medicaid