Provider Demographics
NPI:1063668085
Name:D. DEBRA ROGERS, M.D., P.A.
Entity Type:Organization
Organization Name:D. DEBRA ROGERS, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REIMBURSEMENT COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-863-3195
Mailing Address - Street 1:PO BOX 701306
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78270-1306
Mailing Address - Country:US
Mailing Address - Phone:210-270-7800
Mailing Address - Fax:210-270-7803
Practice Address - Street 1:315 N SAN SABA
Practice Address - Street 2:#1180
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3154
Practice Address - Country:US
Practice Address - Phone:210-270-7800
Practice Address - Fax:210-270-7803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4485207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174322101Medicaid
TXJ4485OtherLICENSE
TXJ4485OtherLICENSE
TX174322101Medicaid