Provider Demographics
NPI:1073087912
Name:RODGERS, ERIN DIANE
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:DIANE
Last Name:RODGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2313 NW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-6931
Mailing Address - Country:US
Mailing Address - Phone:405-837-2567
Mailing Address - Fax:
Practice Address - Street 1:2313 NW 2ND ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-6931
Practice Address - Country:US
Practice Address - Phone:405-837-2567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist