1437126497 NPI number — DR. GAYLON RENARD ROGERS M.D.

Table of content: DR. GAYLON RENARD ROGERS M.D. (NPI 1437126497)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437126497 NPI number — DR. GAYLON RENARD ROGERS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROGERS
Provider First Name:
GAYLON
Provider Middle Name:
RENARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437126497
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2018 BROOKWOOD MEDICAL CTR DR
Provider Second Line Business Mailing Address:
PROFESSIONAL OFFICE BUILDING SUITE 315
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35209-6898
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-877-2747
Provider Business Mailing Address Fax Number:
205-877-2526

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2018 BROOKWOOD MEDICAL CTR DR
Provider Second Line Business Practice Location Address:
PROFESSIONAL OFFICE BUILDING SUITE 315
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35209-6898
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-877-2747
Provider Business Practice Location Address Fax Number:
205-877-2526
Provider Enumeration Date:
03/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  00006106 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 515-48812 . This is a "BCBS - UAB SURGERY" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 000025139 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 25139 . This is a "BCBS BROOKWOOD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 25531 . This is a "BCBS UAB" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-44455 . This is a "BCBS - BROOKWOOD SURGERY" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 000025531 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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