Provider Demographics
NPI:1164577300
Name:RODGERS, HEIDE ALEXANDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:HEIDE
Middle Name:ALEXANDRA
Last Name:RODGERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:607 S NEW BALLAS RD
Mailing Address - Street 2:SUITE 3300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8222
Mailing Address - Country:US
Mailing Address - Phone:314-251-4400
Mailing Address - Fax:314-251-6375
Practice Address - Street 1:607 S NEW BALLAS RD
Practice Address - Street 2:SUITE 3300
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8222
Practice Address - Country:US
Practice Address - Phone:314-251-4400
Practice Address - Fax:314-251-6375
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007000368207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204032106Medicaid
MO204032106Medicaid