Provider Demographics
NPI:1891856902
Name:ROGERS, WILLIAM BRETT (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BRETT
Last Name:ROGERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:69619 ANNA CT
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:MI
Mailing Address - Zip Code:49091-9768
Mailing Address - Country:US
Mailing Address - Phone:269-651-8140
Mailing Address - Fax:
Practice Address - Street 1:916 MYRTLE ST
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:MI
Practice Address - Zip Code:49091-2326
Practice Address - Country:US
Practice Address - Phone:269-659-4266
Practice Address - Fax:269-659-6592
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301044889207Q00000X
TXG0023207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301044889Medicare UPIN