Provider Demographics
NPI:1730114075
Name:RODGERS, MICHAEL K (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:K
Last Name:RODGERS
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 1:207 NE 19TH ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-9927
Mailing Address - Country:US
Mailing Address - Phone:503-435-4514
Mailing Address - Fax:503-435-6349
Practice Address - Street 1:207 NE 19TH ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-9927
Practice Address - Country:US
Practice Address - Phone:503-435-1077
Practice Address - Fax:503-883-5831
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19975207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP00239977OtherRR MEDICARE
G33612Medicare UPIN