Provider Demographics
NPI:1700928967
Name:DR ROGERS MEDICAL GROUP PA.
Entity Type:Organization
Organization Name:DR ROGERS MEDICAL GROUP PA.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMYRA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-495-2117
Mailing Address - Street 1:2838 NORTH LOOP 1604
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1702
Mailing Address - Country:US
Mailing Address - Phone:210-495-2117
Mailing Address - Fax:888-893-4363
Practice Address - Street 1:2838 N LOOP 1604 E
Practice Address - Street 2:STE 104
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1711
Practice Address - Country:US
Practice Address - Phone:210-495-2117
Practice Address - Fax:888-893-4363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3099207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00381XMedicare ID - Type Unspecified