Individual
MR. RUSSELL KEVIN ROGERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1461 N GARDNER ST, SCOTTSBURG, IN 47170-7751
(812) 752-4656
(812) 752-4919
Mailing address
1461 N GARDNER ST, PO BOX 407, SCOTTSBURG, IN 47170-7751
(812) 752-4656
(812) 752-4919
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01035467
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000042514
ANTHEM
KY
05
—
100221450A
—
IN
Enumeration date
11/10/2005
Last updated
07/29/2010
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