Individual
DERRICK THOMAS ROGERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2525 W UNIVERSITY AVE, SUITE 501, MUNCIE, IN 47303-3421
(765) 284-2172
(765) 288-1292
Mailing address
1200 W WHITE RIVER BLVD, MUNCIE, IN 47303-4988
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
01066844
IN
207Y00000X
Otolaryngology Physician
35.084101
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200949350
—
IN
05
—
2488259
—
OH
Enumeration date
07/19/2005
Last updated
02/19/2021
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