Provider Demographics
NPI:1093711962
Name:ROGERS, GARRETT L (MD)
Entity Type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:L
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 1:3080 HENDERSON DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-5246
Mailing Address - Country:US
Mailing Address - Phone:910-353-3000
Mailing Address - Fax:910-238-4456
Practice Address - Street 1:3080 HENDERSON DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-5246
Practice Address - Country:US
Practice Address - Phone:910-353-3000
Practice Address - Fax:910-238-4456
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21109207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8972939Medicaid
NC8972939Medicaid
NC213291GMedicare PIN
NC213291HMedicare PIN
NCC21246Medicare UPIN