Provider Demographics
NPI:1437107349
Name:ROGERS, PAUL WESLEY JR (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:WESLEY
Last Name:ROGERS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:PAUL
Other - Middle Name:WESLEY
Other - Last Name:ROGERS
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1232 W 28TH PL
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-3404
Mailing Address - Country:US
Mailing Address - Phone:850-215-6303
Mailing Address - Fax:850-215-6304
Practice Address - Street 1:1232 W 28TH PL
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-3404
Practice Address - Country:US
Practice Address - Phone:850-215-6303
Practice Address - Fax:850-215-6304
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00017686207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009937832Medicaid
AL051531827Medicaid
AL051557986Medicare PIN
ALF67525Medicare UPIN
AL051531827Medicaid