Provider Demographics
NPI:1083049357
Name:ROGERS, ANNA EVELYN (MD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:EVELYN
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 E GREEN AVE
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-6043
Mailing Address - Country:US
Mailing Address - Phone:805-245-4893
Mailing Address - Fax:
Practice Address - Street 1:1280 E 32ND ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-7229
Practice Address - Country:US
Practice Address - Phone:575-388-1561
Practice Address - Fax:575-388-9952
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA127557207Q00000X
390200000X
NMMD2022-1512207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program