Provider Demographics
NPI:1881056513
Name:RODGER, JAIMIE DAWN (DO)
Entity type:Individual
Prefix:
First Name:JAIMIE
Middle Name:DAWN
Last Name:RODGER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JAIMIE
Other - Middle Name:DAWN
Other - Last Name:NUCKOLLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:3535 OLENTANGY RIVER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3998
Mailing Address - Country:US
Mailing Address - Phone:614-566-4398
Mailing Address - Fax:
Practice Address - Street 1:2359 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BEXLEY
Practice Address - State:OH
Practice Address - Zip Code:43209-2421
Practice Address - Country:US
Practice Address - Phone:614-947-1716
Practice Address - Fax:614-947-1743
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58008123207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology