Provider Demographics
NPI:1639460462
Name:RODGERS, GARY (ATP)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:
Last Name:RODGERS
Suffix:
Gender:M
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 N HIGHWAY 360
Mailing Address - Street 2:SUITE 1802
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-1011
Mailing Address - Country:US
Mailing Address - Phone:972-647-8567
Mailing Address - Fax:972-660-4548
Practice Address - Street 1:2100 N HIGHWAY 360
Practice Address - Street 2:SUITE 1802
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-1011
Practice Address - Country:US
Practice Address - Phone:972-647-8567
Practice Address - Fax:972-660-4548
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other