Provider Demographics
NPI:1679675433
Name:ROGERS, CORBIN B (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CORBIN
Middle Name:B
Last Name:ROGERS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 E HARVARD AVE
Mailing Address - Street 2:STE 440
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-7009
Mailing Address - Country:US
Mailing Address - Phone:303-744-2704
Mailing Address - Fax:303-744-3244
Practice Address - Street 1:950 E HARVARD AVE
Practice Address - Street 2:STE 440
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-7009
Practice Address - Country:US
Practice Address - Phone:303-744-2704
Practice Address - Fax:303-744-3244
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1700363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP00087580OtherRR MEDICARE
COC489298Medicare UPIN
COP00087580OtherRR MEDICARE