Provider Demographics
NPI:1013945419
Name:ROGERS, BRUCE W (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:W
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 1:200 W ASH ST
Mailing Address - Street 2:STE 202
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-3662
Mailing Address - Country:US
Mailing Address - Phone:919-731-4941
Mailing Address - Fax:919-731-2416
Practice Address - Street 1:200 W ASH ST
Practice Address - Street 2:STE 202
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-3662
Practice Address - Country:US
Practice Address - Phone:919-731-4941
Practice Address - Fax:919-731-2416
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32563207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D92676Medicare UPIN