1659381663 NPI number — DORA D ROGERS MD

Table of content: DORA D ROGERS MD (NPI 1659381663)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659381663 NPI number — DORA D ROGERS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROGERS
Provider First Name:
DORA
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROGERS
Provider Other First Name:
D
Provider Other Middle Name:
DEBRA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1659381663
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 701306
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78270-1306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-270-7800
Provider Business Mailing Address Fax Number:
210-270-7803

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 N SAN SABA
Provider Second Line Business Practice Location Address:
STE 1180
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78207-3154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-270-7800
Provider Business Practice Location Address Fax Number:
210-270-7803
Provider Enumeration Date:
08/09/2006

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: 207V00000X , with the licence number:  J4485 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 174323903 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 174323905 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 174323902 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 174323901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 174323909 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8BD729 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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