Provider Demographics
NPI:1134234883
Name:P. BRIAN ROGERS, M.D., INC. P.S.
Entity type:Organization
Organization Name:P. BRIAN ROGERS, M.D., INC. P.S.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL OFFICE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOFFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-586-0903
Mailing Address - Street 1:1727 W COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-4913
Mailing Address - Country:US
Mailing Address - Phone:406-587-4432
Mailing Address - Fax:406-587-7015
Practice Address - Street 1:1727 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-4913
Practice Address - Country:US
Practice Address - Phone:406-587-4432
Practice Address - Fax:406-587-7015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000083053Medicare ID - Type UnspecifiedGROUP