Provider Demographics
NPI:1134108962
Name:ROGERS, TAMYRA L (MD)
Entity Type:Individual
Prefix:
First Name:TAMYRA
Middle Name:L
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 1:2838 N LOOP 1604 E
Mailing Address - Street 2:STE 104
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1712
Mailing Address - Country:US
Mailing Address - Phone:210-495-2117
Mailing Address - Fax:888-893-4363
Practice Address - Street 1:2838 N LOOP 1604 E
Practice Address - Street 2:STE. 104
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1711
Practice Address - Country:US
Practice Address - Phone:210-495-2117
Practice Address - Fax:888-893-4363
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3099207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0025LNOtherBCBS
TXH50230Medicare UPIN
TX8C6108Medicare ID - Type Unspecified