Provider Demographics
NPI:1134147499
Name:ROGERS, ANITA GAYLE (MD)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:GAYLE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 SHOPPERS DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-2808
Mailing Address - Country:US
Mailing Address - Phone:859-737-3911
Mailing Address - Fax:859-737-9511
Practice Address - Street 1:505 SHOPPERS DR
Practice Address - Street 2:SUITE 3
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-2808
Practice Address - Country:US
Practice Address - Phone:859-737-3911
Practice Address - Fax:859-737-9511
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26795207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6426795800Medicaid
KY26795OtherKY MEDICAL LICENSE NUMBER
000000221170OtherANTHEM PROVIDER ID
KY26795OtherKY MEDICAL LICENSE NUMBER
KY6426795800Medicaid