Provider Demographics
NPI:1275545147
Name:ROGERS, CHARLES PETER (MD FACC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:PETER
Last Name:ROGERS
Suffix:
Gender:M
Credentials:MD FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 WESTERN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2709
Mailing Address - Country:US
Mailing Address - Phone:303-442-2395
Mailing Address - Fax:303-442-1073
Practice Address - Street 1:2101 KEN PRATT BLVD STE 104
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6568
Practice Address - Country:US
Practice Address - Phone:303-442-2395
Practice Address - Fax:303-442-1073
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0038114207R00000X
CO38114207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO52923771Medicaid
COCOAAA0100Medicare PIN
CO52923771Medicaid