Provider Demographics
NPI:1508156720
Name:ROGERS, DUKE (RN)
Entity Type:Individual
Prefix:MR
First Name:DUKE
Middle Name:
Last Name:ROGERS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3796 E PRESIDENTIAL DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-6035
Mailing Address - Country:US
Mailing Address - Phone:208-866-3897
Mailing Address - Fax:
Practice Address - Street 1:3796 E PRESIDENTIAL DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6035
Practice Address - Country:US
Practice Address - Phone:208-866-3897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID003722603332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies