Provider Demographics
NPI:1629043179
Name:ROGERS, SUSAN B (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:B
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:399 W CAMPBELL RD
Mailing Address - Street 2:#101
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3595
Mailing Address - Country:US
Mailing Address - Phone:972-238-1848
Mailing Address - Fax:972-238-8735
Practice Address - Street 1:399 W CAMPBELL RD
Practice Address - Street 2:#101
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3595
Practice Address - Country:US
Practice Address - Phone:972-238-1848
Practice Address - Fax:972-238-8735
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6004207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4019553OtherAETNA NON-HMO
TX098426203Medicaid
TX080154026OtherRAILROAD MEDICARE
TX2266929OtherAETNA HMO
TXP00845040OtherRR MC
TX00FV75OtherBCBS
TX00FV75OtherBCBS
TX080154026OtherRAILROAD MEDICARE
TX8F24102Medicare PIN