1427039916 NPI number — VANCE D RODGERS M.D.

Table of content: VANCE D RODGERS M.D. (NPI 1427039916)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427039916 NPI number — VANCE D RODGERS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODGERS
Provider First Name:
VANCE
Provider Middle Name:
D
Provider Name Prefix Text:
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:
1427039916
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 E. CHURCH STREET
Provider Second Line Business Mailing Address:
ATTENTION- MEDICAL STAFF OFFICE
Provider Business Mailing Address City Name:
SANTA MARIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93454
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-739-3954
Provider Business Mailing Address Fax Number:
805-739-3060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1551 BISHOP ST STE 230
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN LUIS OBISPO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93401-4661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-434-5530
Provider Business Practice Location Address Fax Number:
805-786-4220
Provider Enumeration Date:
11/10/2005

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: 207RG0100X , with the licence number:  G44433 , 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)

  • Identifier: 00G444330 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: G44433 . This is a "MEDICAL LICENSE NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".