Provider Demographics
NPI:1134423726
Name:RYAN W. ROGERS, M.D., P.C.
Entity type:Organization
Organization Name:RYAN W. ROGERS, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-588-7816
Mailing Address - Street 1:2100 CALLE DE LA VUELTA
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4742
Mailing Address - Country:US
Mailing Address - Phone:505-982-8831
Mailing Address - Fax:505-983-2763
Practice Address - Street 1:2100 CALLE DE LA VUELTA
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4742
Practice Address - Country:US
Practice Address - Phone:505-982-8831
Practice Address - Fax:505-983-2763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2010-0725207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty