Provider Demographics
NPI:1881622652
Name:ROGERS, GARY L (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:L
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 1:1600 116TH AVE NE
Mailing Address - Street 2:#104
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3014
Mailing Address - Country:US
Mailing Address - Phone:425-454-0345
Mailing Address - Fax:
Practice Address - Street 1:1600 116TH AVE NE
Practice Address - Street 2:#104
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3014
Practice Address - Country:US
Practice Address - Phone:425-454-0345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00013973207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1008929Medicaid
WA1008929Medicaid
GAB35021Medicare PIN