Provider Demographics
NPI:1831319292
Name:RODGERS, BRUCE ALLEN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ALLEN
Last Name:RODGERS
Suffix:JR
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 1:24022 CINCO VILLAGE CENTER BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-8397
Mailing Address - Country:US
Mailing Address - Phone:281-578-7600
Mailing Address - Fax:281-578-7600
Practice Address - Street 1:24022 CINCO VILLAGE CENTER BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-8397
Practice Address - Country:US
Practice Address - Phone:281-578-7600
Practice Address - Fax:281-578-7600
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM63642086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Y526OtherGROUP PTAN
TX00Y526OtherGROUP PTAN
TX8F6993Medicare PIN