| Doctor Name: | BRIAN RODGERS |
| NPI Number: | 1003048323 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 68505 |
| Business Practice Address: | 202 Maplewood Ave Ronceverte, WV - 249701334 |
| Business Phone Number: | 3046672855 |
| Business Fax Number: | |
| Mailing Address: | 202 Maplewood Ave, RONCEVERTE |
| State: | WV |
| Postal Code: | 249701334 |
| Phone Number: | 3046672855 |
| Fax Number: | |
| NPI Enumeration Date: | 08/20/2009 |
| NPI Last Update Date: | 08/20/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WC0200X |
| License Number: | 68505 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WV |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Critical Care Medicine |
| Taxonomy Definition: | |