Provider Demographics
NPI:1184828261
Name:ROGERS, BRIAN (DO)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:ROGERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 MEDICAL PKWY STE 108
Mailing Address - Street 2:
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7868
Mailing Address - Country:US
Mailing Address - Phone:214-382-9894
Mailing Address - Fax:817-887-5042
Practice Address - Street 1:7125 MARVIN D LOVE FWY STE 107
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3111
Practice Address - Country:US
Practice Address - Phone:214-382-9891
Practice Address - Fax:817-887-5042
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6034207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXJ6034OtherSTATE LICENSE