Provider Demographics
NPI:1467462663
Name:ROGERS, TAMMIE LEA (MD)
Entity Type:Individual
Prefix:DR
First Name:TAMMIE
Middle Name:LEA
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3450 W WHEATLAND RD
Mailing Address - Street 2:SUITE 325
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-3470
Mailing Address - Country:US
Mailing Address - Phone:927-283-9400
Mailing Address - Fax:972-283-9120
Practice Address - Street 1:3450 W WHEATLAND RD
Practice Address - Street 2:SUITE 325
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3470
Practice Address - Country:US
Practice Address - Phone:927-283-9400
Practice Address - Fax:972-283-9120
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8746207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG49607Medicare UPIN
TX82V276Medicare ID - Type Unspecified