Provider Demographics
NPI:1942208434
Name:ROGERS, JAMES W (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:W
Last Name:ROGERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:6210 E HIGHWAY 290 STE 420
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1142
Mailing Address - Country:US
Mailing Address - Phone:512-483-9569
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:940 W UNIVERSITY AVE STE 101
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-5430
Practice Address - Country:US
Practice Address - Phone:512-819-0264
Practice Address - Fax:512-406-6242
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1431207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX201356701Medicaid
TX201356702Medicaid
TX201356703Medicaid
TX272142YKXVMedicare PIN
TX8F10102Medicare PIN
TXP01174939Medicare PIN
TX272142YKXYMedicare PIN