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Individual

TYRONE ROGERS JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
8040 CLEARVISTA PKWY STE 490, INDIANAPOLIS, IN 46256-5604
(317) 621-5450
(317) 621-5453
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
(317) 621-1647

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01083772A
IN
390200000X
Student in an Organized Health Care Education/Training Program

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
300038778
IN
Enumeration date
05/08/2014
Last updated
11/27/2023
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