Provider Demographics
NPI:1598837684
Name:ROGERS, RICHARD EARL (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:EARL
Last Name:ROGERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3703
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77903
Mailing Address - Country:US
Mailing Address - Phone:361-582-5711
Mailing Address - Fax:361-582-5712
Practice Address - Street 1:2700 CITIZENS PLAZA
Practice Address - Street 2:SUITE 403
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901
Practice Address - Country:US
Practice Address - Phone:361-582-5711
Practice Address - Fax:361-582-5712
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8384207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122939502Medicaid
TX122939502Medicaid
TX00G07DMedicare PIN