Individual
ETHAN ROGERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
743 SPRING ST, GAINESVILLE, GA 30501
(678) 862-1796
(770) 533-8949
Mailing address
743 SPRING ST, GAINESVILLE, GA 30501
(678) 862-1796
(770) 533-8949
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
059926
GA
207P00000X
Emergency Medicine Physician
ME99797
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
429866120C
—
GA
01
—
GRP4155
MEDICARE GROUP NUMBER
GA
Enumeration date
01/12/2007
Last updated
10/08/2008
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