Provider Demographics
NPI:1801419940
Name:ROGERS, BRIAN DAVID (DO)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:DAVID
Last Name:ROGERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMG VILLAGE-MAIN
Mailing Address - Street 2:4830 RUCKER ROAD
Mailing Address - City:MONETA
Mailing Address - State:VA
Mailing Address - Zip Code:24121-5281
Mailing Address - Country:US
Mailing Address - Phone:540-297-7181
Mailing Address - Fax:540-297-6145
Practice Address - Street 1:CMG VILLAGE-MAIN
Practice Address - Street 2:4830 RUCKER ROAD
Practice Address - City:MONETA
Practice Address - State:VA
Practice Address - Zip Code:24121-5281
Practice Address - Country:US
Practice Address - Phone:540-297-7181
Practice Address - Fax:540-297-6145
Is Sole Proprietor?:No
Enumeration Date:2020-05-23
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVED0921A390200000X
VA0102207851207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program