Provider Demographics
NPI:1528091469
Name:ROGERS, HENRY LYLE (MD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:LYLE
Last Name:ROGERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 W 40TH AVE
Mailing Address - Street 2:SUITE 5A
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-6940
Mailing Address - Country:US
Mailing Address - Phone:870-536-7660
Mailing Address - Fax:870-536-6750
Practice Address - Street 1:1801 W 40TH AVE
Practice Address - Street 2:SUITE 5A
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-6940
Practice Address - Country:US
Practice Address - Phone:870-536-7660
Practice Address - Fax:870-536-6750
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC4638207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARD04885Medicare UPIN
AR54489Medicare ID - Type Unspecified