Provider Demographics
NPI:1336307768
Name:RODGERS, JANET ELAINE
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:ELAINE
Last Name:RODGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:JANET
Other - Middle Name:ELAINE
Other - Last Name:GILLAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1729
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-1729
Mailing Address - Country:US
Mailing Address - Phone:405-419-2730
Mailing Address - Fax:405-530-7258
Practice Address - Street 1:6501 NW 11TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73127-4301
Practice Address - Country:US
Practice Address - Phone:405-419-2730
Practice Address - Fax:405-530-7258
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10819207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine