Basic Information
Provider Information
NPI: 1740204676
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROGERS
FirstName: GINGER
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1324 BEACH BLVD
Address2:  
City: BILOXI
State: MS
PostalCode: 395303527
CountryCode: US
TelephoneNumber: 2283417574
FaxNumber:  
Practice Location
Address1: 400 VETERANS AVE
Address2:  
City: BILOXI
State: MS
PostalCode: 395312410
CountryCode: US
TelephoneNumber: 2285235000
FaxNumber: 2285234342
Other Information
ProviderEnumerationDate: 07/26/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RH0000X042411GAY Allopathic & Osteopathic PhysiciansInternal MedicineHematology

No ID Information.


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