Provider Demographics
NPI:1639606130
Name:ROGERS, MATTHEW W (DO)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:W
Last Name:ROGERS
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1388 BUCKMAN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:CAMPO
Mailing Address - State:CA
Mailing Address - Zip Code:91906-2028
Mailing Address - Country:US
Mailing Address - Phone:619-445-6200
Mailing Address - Fax:619-824-9071
Practice Address - Street 1:1388 BUCKMAN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:CAMPO
Practice Address - State:CA
Practice Address - Zip Code:91906-2028
Practice Address - Country:US
Practice Address - Phone:619-445-6200
Practice Address - Fax:619-824-9071
Is Sole Proprietor?:No
Enumeration Date:2017-05-15
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2018-02308207Q00000X
CA20A18400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine