Provider Demographics
NPI:1255395067
Name:RODGERS, TIMOTHY
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:RODGERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3880 PARKWOOD BLVD
Mailing Address - Street 2:102
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-1928
Mailing Address - Country:US
Mailing Address - Phone:972-704-2400
Mailing Address - Fax:
Practice Address - Street 1:3880 PARKWOOD BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-8592
Practice Address - Country:US
Practice Address - Phone:972-704-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2776207NP0225X, 207NS0135X, 207ND0101X, 207N00000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology