Provider Demographics
NPI:1710969720
Name:ROGERS, JOANNE LAVETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:LAVETTE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 FROSTWOOD DR
Mailing Address - Street 2:SUITE 1.100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2301
Mailing Address - Country:US
Mailing Address - Phone:713-338-4523
Mailing Address - Fax:
Practice Address - Street 1:5303 BISSONNET ST
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-3911
Practice Address - Country:US
Practice Address - Phone:713-984-6627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK34516207Q00000X
PAMD466641207Q00000X
LA312449207Q00000X
ORMD190989207Q00000X
NMMD2019-0458207Q00000X
TXJ0230207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00R27FOtherBLUE CROSS BLUE SHIELD
TX134136408Medicaid
F41519Medicare UPIN
TX134136408Medicaid