Provider Demographics
NPI:1417932674
Name:ROGERS, MATTHEW THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:THOMAS
Last Name:ROGERS
Suffix:
Gender:M
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:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:800-994-0371
Mailing Address - Fax:254-215-9722
Practice Address - Street 1:50 HILLCREST MEDICAL BLVD STE 303
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-8955
Practice Address - Country:US
Practice Address - Phone:254-202-0480
Practice Address - Fax:254-202-0488
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6557207RI0011X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX129151014Medicaid
TX8CN880OtherBCBS
TX129151012Medicaid
TX129151011Medicaid
TX129151015Medicaid
TXP01480868OtherRAILROAD MEDICARE
TX332056YL9XMedicare PIN
TXP01480868OtherRAILROAD MEDICARE
TX129151012Medicaid