Provider Demographics
NPI:1104367531
Name:ROGERS, ELISE BREAUX (MD)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:BREAUX
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 1:17189 INTERSTATE 45 S STE 395
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77385-3319
Mailing Address - Country:US
Mailing Address - Phone:936-270-3662
Mailing Address - Fax:936-270-3665
Practice Address - Street 1:17189 INTERSTATE 45 S STE 395
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77385-3319
Practice Address - Country:US
Practice Address - Phone:936-270-3662
Practice Address - Fax:936-270-3665
Is Sole Proprietor?:No
Enumeration Date:2017-03-18
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT2054207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology