Provider Demographics
NPI:1043206097
Name:ROGERS, DAVID A (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:ROGERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FOT 1207
Mailing Address - Street 2:1720 2ND AVE S
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35294-3412
Mailing Address - Country:US
Mailing Address - Phone:205-934-8744
Mailing Address - Fax:205-934-8777
Practice Address - Street 1:FOT 1207
Practice Address - Street 2:1720 2ND AVE S
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35294-3412
Practice Address - Country:US
Practice Address - Phone:205-934-8744
Practice Address - Fax:205-934-8777
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL319862086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036102104Medicaid
E61382Medicare UPIN
ILL77689Medicare ID - Type Unspecified