Provider Demographics
NPI:1669669081
Name:ROGAN, GERALD NEAL (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:NEAL
Last Name:ROGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 HIGHLEY CT
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-6912
Mailing Address - Country:US
Mailing Address - Phone:916-978-9636
Mailing Address - Fax:916-978-9637
Practice Address - Street 1:107 HIGHLEY CT
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95864-6912
Practice Address - Country:US
Practice Address - Phone:916-978-9636
Practice Address - Fax:916-978-9637
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG25626207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG25626OtherMEDICAL LICENSE NUMBER
CAG25626OtherMEDICAL LICENSE NUMBER