Provider Demographics
NPI:1881676518
Name:ROGERS, PAUL L (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:L
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:PO BOX 5865
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79408-5865
Mailing Address - Country:US
Mailing Address - Phone:806-743-2898
Mailing Address - Fax:806-743-2787
Practice Address - Street 1:3601 4TH ST
Practice Address - Street 2:SUITE 4B174
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-0002
Practice Address - Country:US
Practice Address - Phone:806-743-7337
Practice Address - Fax:806-743-2314
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD6154208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM64446OtherPRESBYTERIAN COMMERCIAL
NMA396OtherTRIWEST
TX83796ZOtherHMO BLUE
TX87524JOtherBC/BS
NMX2983Medicaid
NM64446Medicaid
NMX2983Medicaid
TX87524JOtherBC/BS