Provider Demographics
NPI:1467453423
Name:ROGERS, MARK R (MDPA)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:R
Last Name:ROGERS
Suffix:
Gender:M
Credentials:MDPA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:12000 RICHMOND AVE
Mailing Address - Street 2:#370
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082
Mailing Address - Country:US
Mailing Address - Phone:281-497-9993
Mailing Address - Fax:281-497-9991
Practice Address - Street 1:12000 RICHMOND AVE
Practice Address - Street 2:#370
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082
Practice Address - Country:US
Practice Address - Phone:281-497-9993
Practice Address - Fax:281-497-9991
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH0770207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX125224905Medicaid
TX125224905Medicaid
TX00957MMedicare PIN
B07173Medicare UPIN
1467453423Medicare Oscar/Certification