1265877237 NPI number — AMERIMED

Table of content: DR. ROBERT MARK RODGER MD (NPI 1811953474)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265877237 NPI number — AMERIMED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERIMED
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1265877237
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1300 WHITE OAKS RD
Provider Second Line Business Mailing Address:
SUITE 206
Provider Business Mailing Address City Name:
CAMPBELL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95008-6781
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-355-4732
Provider Business Mailing Address Fax Number:
866-387-0342

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 WHITE OAKS RD
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
CAMPBELL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95008-6781
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-355-4732
Provider Business Practice Location Address Fax Number:
866-387-0342
Provider Enumeration Date:
05/05/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MOGASBE
Authorized Official First Name:
ABDELSALAM
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
408-596-6278

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  A97753 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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