Provider Demographics
NPI:1982633475
Name:ROGERS, ROBERT MANNING JR (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MANNING
Last Name:ROGERS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:307 BLANCHARD HOLW
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-8253
Mailing Address - Country:US
Mailing Address - Phone:406-752-8282
Mailing Address - Fax:406-257-2225
Practice Address - Street 1:75 CLAREMONT ST
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3585
Practice Address - Country:US
Practice Address - Phone:406-752-8282
Practice Address - Fax:406-257-2225
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2023-11-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MT10632207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0145912Medicaid
MTC29711Medicare UPIN