Provider Demographics
NPI:1639992969
Name:ROGERS, JEFFREY
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:
Last Name:ROGERS
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 1:1337 GUSDORF RD STE O
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6298
Mailing Address - Country:US
Mailing Address - Phone:505-231-8419
Mailing Address - Fax:
Practice Address - Street 1:1337 GUSDORF RD STE O
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6298
Practice Address - Country:US
Practice Address - Phone:505-231-8419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical