Provider Demographics
NPI:1053312710
Name:ROGERS, JOSHUA B (MD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:B
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:PO BOX 9578
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96158-9578
Mailing Address - Country:US
Mailing Address - Phone:530-542-3000
Mailing Address - Fax:530-541-2512
Practice Address - Street 1:1107 US HIGHWAY 395 N
Practice Address - Street 2:
Practice Address - City:GARDNERVILLE
Practice Address - State:NV
Practice Address - Zip Code:89410-5304
Practice Address - Country:US
Practice Address - Phone:775-782-1600
Practice Address - Fax:775-782-1633
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12876207P00000X
VA0101238084207P00000X
CAA105542207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1053312710Medicaid
CA1053312710Medicaid
NV1053312710Medicaid
CA1053312710Medicare PIN
NV1053312710Medicaid
VA021187V21Medicare PIN
NV1053312710Medicare PIN
VA021714V20Medicare PIN