Provider Demographics
NPI:1720197817
Name:ROGERS, P BRIAN (MD)
Entity Type:Individual
Prefix:
First Name:P
Middle Name:BRIAN
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 1:1727 W COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-4913
Mailing Address - Country:US
Mailing Address - Phone:406-587-4432
Mailing Address - Fax:406-587-7015
Practice Address - Street 1:1727 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-4913
Practice Address - Country:US
Practice Address - Phone:406-587-4432
Practice Address - Fax:406-587-7015
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3774207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTD07935Medicare UPIN
MT000083365Medicare ID - Type UnspecifiedINDIVIDUAL