1992779110 NPI number — DR. MELVIN ERIC RODGERS FNP, PHD

Table of content: DR. MELVIN ERIC RODGERS FNP, PHD (NPI 1992779110)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992779110 NPI number — DR. MELVIN ERIC RODGERS FNP, PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODGERS
Provider First Name:
MELVIN
Provider Middle Name:
ERIC
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
FNP, PHD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RODGERS
Provider Other First Name:
M.
Provider Other Middle Name:
ERIC
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP, PHD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1992779110
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1055 CLERMONT ST
Provider Second Line Business Mailing Address:
MAILSTOP 118
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80220-3808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-393-2859
Provider Business Mailing Address Fax Number:
303-393-4687

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1055 CLERMONT ST
Provider Second Line Business Practice Location Address:
MAILSTOP 118
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80220-3808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-393-2859
Provider Business Practice Location Address Fax Number:
303-393-4687
Provider Enumeration Date:
02/14/2006

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: 363LF0000X , with the licence number:  71359 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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