Provider Demographics
NPI:1619041415
Name:ROGERS, WILLIAM RANDOLPH (DO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:RANDOLPH
Last Name:ROGERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 E SIERRA CIR
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-2534
Mailing Address - Country:US
Mailing Address - Phone:512-396-3963
Mailing Address - Fax:
Practice Address - Street 1:310 STAGECOACH TRL
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-5134
Practice Address - Country:US
Practice Address - Phone:512-396-4700
Practice Address - Fax:512-396-4796
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5912207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF0027239OtherTX CONTROLLED SUBSTANCE
TXE5912OtherMEDICAL LICENSE NUMBER
TXE5912OtherMEDICAL LICENSE NUMBER
TXAR9001429OtherDEA NUMBER
TX00AF56Medicare ID - Type Unspecified