Provider Demographics
NPI:1093764300
Name:RODGERS, BRIAN MURRAY (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:MURRAY
Last Name:RODGERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BRIAN
Other - Middle Name:MURRAY
Other - Last Name:RODGERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1415 TULANE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2600
Mailing Address - Country:US
Mailing Address - Phone:504-988-7627
Mailing Address - Fax:504-988-7616
Practice Address - Street 1:1415 TULANE AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2600
Practice Address - Country:US
Practice Address - Phone:504-988-7627
Practice Address - Fax:504-988-7616
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL 13049R2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1557064Medicaid
MS00121840Medicaid
AR009941026Medicaid
C67927Medicare UPIN
LA1557064Medicaid
P00378207Medicare PIN