Provider Demographics
NPI:1073634697
Name:RODGERS, WILLIAM P (CO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:P
Last Name:RODGERS
Suffix:
Gender:M
Credentials:CO
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 245
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80539-0245
Mailing Address - Country:US
Mailing Address - Phone:970-203-1234
Mailing Address - Fax:970-593-1520
Practice Address - Street 1:750 E 57TH ST
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-1246
Practice Address - Country:US
Practice Address - Phone:970-203-1234
Practice Address - Fax:970-797-4828
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08002701Medicaid