Provider Demographics
NPI:1730480518
Name:ROGERS, RUTH FASSIE
Entity Type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:FASSIE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9560 SKILLMAN ST
Mailing Address - Street 2:SUITE 126
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-8256
Mailing Address - Country:US
Mailing Address - Phone:214-340-8700
Mailing Address - Fax:214-246-1998
Practice Address - Street 1:9560 SKILLMAN ST
Practice Address - Street 2:SUITE 126
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-8256
Practice Address - Country:US
Practice Address - Phone:214-340-8700
Practice Address - Fax:214-246-1998
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX130173373H00000X
373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130173Medicaid
TX104319Medicaid
TX37Medicaid