Provider Demographics
NPI:1649216862
Name:ROGERS, BROOKS TOLLEY (MD)
Entity type:Individual
Prefix:DR
First Name:BROOKS
Middle Name:TOLLEY
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5215 96TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-4413
Mailing Address - Country:US
Mailing Address - Phone:806-780-6868
Mailing Address - Fax:806-780-2065
Practice Address - Street 1:5215 96TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-4413
Practice Address - Country:US
Practice Address - Phone:806-780-6868
Practice Address - Fax:806-780-2065
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2991208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
87601NMedicare ID - Type Unspecified
G94297Medicare UPIN