Provider Demographics
NPI:1750599890
Name:ROGERS, MARK (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:ROGERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 JOHN FREEMAN BLVD
Mailing Address - Street 2:JJL 451-D
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3412
Mailing Address - Country:US
Mailing Address - Phone:713-500-7882
Mailing Address - Fax:
Practice Address - Street 1:1133 JOHN FREEMAN BLVD
Practice Address - Street 2:JJL 451-D
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3412
Practice Address - Country:US
Practice Address - Phone:713-500-7882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ0167207P00000X
TX110-48-21-096207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine