Provider Demographics
NPI:1639283070
Name:ROGERS, EVERETT JOAQUIN
Entity Type:Individual
Prefix:DR
First Name:EVERETT
Middle Name:JOAQUIN
Last Name:ROGERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 N. WILMOT ROAD
Mailing Address - Street 2:ST JOSEPHS HOSPITAL O'RIELLY CARE CENTER
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711
Mailing Address - Country:US
Mailing Address - Phone:520-873-5182
Mailing Address - Fax:520-873-5520
Practice Address - Street 1:350 N. WILMOT ROAD
Practice Address - Street 2:ST JOSEPHS HOSPITAL O'RIELLY CARE CENTER
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711
Practice Address - Country:US
Practice Address - Phone:520-873-5182
Practice Address - Fax:520-873-5520
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ277472084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry