Provider Demographics
NPI:1821127945
Name:ROGERS, TERRY REID (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:REID
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 1:12001 4TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-4518
Mailing Address - Country:US
Mailing Address - Phone:206-465-6601
Mailing Address - Fax:206-306-8946
Practice Address - Street 1:12001 4TH AVE NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98177-4518
Practice Address - Country:US
Practice Address - Phone:206-465-6601
Practice Address - Fax:206-306-8946
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00010090207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAA05498Medicare UPIN