Basic Information
| Provider Information | |||||||||
| NPI: | 1285656652 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROGERS | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | SIMS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 15004 | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655229730 | ||||||||
| FaxNumber: | 8656372520 | ||||||||
| Practice Location | |||||||||
| Address1: | 2100 W CLINCH AVE | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379162219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8656378481 | ||||||||
| FaxNumber: | 8656379959 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2006 | ||||||||
| LastUpdateDate: | 01/27/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MD0000024782 | TN | N | Other Service Providers | Specialist | 2080P0214X | MD0000024782 | TN | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Pulmonology |
ID Information
| ID | Type | State | Issuer | Description | 3079515 | 05 | TN | MEDICAID | 0180359 | 01 | TN | BCBS | OTHER |