Provider Demographics
NPI:1891760419
Name:ROGERS, PAMELA JANE (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:JANE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:JANE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1510
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-1510
Mailing Address - Country:US
Mailing Address - Phone:812-853-5300
Mailing Address - Fax:812-858-4660
Practice Address - Street 1:4111 GATEWAY BLVD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8954
Practice Address - Country:US
Practice Address - Phone:812-853-5300
Practice Address - Fax:812-858-4660
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061308A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200825360Medicaid
IN000000392427OtherBCBS PIN
IN257900HHMedicare PIN
IN191410EMedicare PIN
IN000000392427OtherBCBS PIN