Provider Demographics
NPI:1659455327
Name:ROGERS, JEFFREY B (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:B
Last Name:ROGERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 99371
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0371
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-7347
Practice Address - Street 1:3200 RIVERFRONT DR
Practice Address - Street 2:STE 103
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-6570
Practice Address - Country:US
Practice Address - Phone:817-336-3800
Practice Address - Fax:817-335-9454
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2736208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177056201Medicaid
TX00U87ZOtherBCBSTX GRP PIN
TX86W592OtherBCBSTX IND PIN
TX133996OtherUHC PIN
1750369203OtherGRP NPI NUMBER
TX177056202Medicaid
TXROGJE46797OtherCCHIP PIN
TX115129204Medicaid
TX1640342OtherFIRSTHEALTH PIN
TX2847964OtherCIGNA PIN
TX4140242OtherAETNA PIN
TX115129203Medicaid
TX137345801Medicaid
TX8F1579Medicare PIN
TXROGJE46797OtherCCHIP PIN
TX4140242OtherAETNA PIN
TX1640342OtherFIRSTHEALTH PIN
1750369203OtherGRP NPI NUMBER