Provider Demographics
NPI:1861580946
Name:ROGERS, WILLIAM B III (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:B
Last Name:ROGERS
Suffix:III
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:PO BOX 2379
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2379
Mailing Address - Country:US
Mailing Address - Phone:606-324-7146
Mailing Address - Fax:606-324-5165
Practice Address - Street 1:617 23RD ST STE 105
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2890
Practice Address - Country:US
Practice Address - Phone:606-408-7500
Practice Address - Fax:606-408-6600
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29561208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64295611Medicaid
OH1554301Medicaid
WV3810018837Medicaid
KYP00885634OtherRR MEDICARE
OH0331617Medicaid
KY64295611Medicaid
WV3810018837Medicaid