Provider Demographics
NPI:1912169467
Name:ROBERT J. ROGERS, M.D., P.A.
Entity Type:Organization
Organization Name:ROBERT J. ROGERS, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-315-2550
Mailing Address - Street 1:4200 S HULEN ST STE 230
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4924
Mailing Address - Country:US
Mailing Address - Phone:818-315-2550
Mailing Address - Fax:817-732-4660
Practice Address - Street 1:4200 S HULEN ST STE 230
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-4924
Practice Address - Country:US
Practice Address - Phone:818-315-2550
Practice Address - Fax:817-732-4660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4444261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX033448401Medicaid
TX033448401Medicaid
TXC21229Medicare UPIN