Individual
DR. BLAKE CONLEY RODGERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1414 CROSS ST STE 230, SHILOH, IL 62269-2988
(618) 607-1260
(618) 624-4856
Mailing address
1414 CROSS ST STE 230, SHILOH, IL 62269-2988
(618) 607-1260
(618) 624-4856
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036.122904
IL
207Q00000X
Family Medicine Physician
27273
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27273
NE STATE LICENSE
NE
Enumeration date
12/07/2006
Last updated
03/15/2021
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