Provider Demographics
NPI:1598116329
Name:BROGIS, ROGER JOEL II (DO)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:JOEL
Last Name:BROGIS
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:RJ
Other - Middle Name:
Other - Last Name:BROGIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:275 S ASPEN ST STOP 90
Mailing Address - Street 2:
Mailing Address - City:BUCKLEY AFB
Mailing Address - State:CO
Mailing Address - Zip Code:80011-9562
Mailing Address - Country:US
Mailing Address - Phone:720-847-1703
Mailing Address - Fax:
Practice Address - Street 1:701 HOSPITAL LOOP
Practice Address - Street 2:
Practice Address - City:FAIRCHILD AFB
Practice Address - State:WA
Practice Address - Zip Code:99011-8704
Practice Address - Country:US
Practice Address - Phone:509-247-2361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-22
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP61015230207PE0004X
NE7752207Q00000X
CODR.0072183207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE7752OtherNEBRASKA TEMPORARY EDUCATION PERMIT