Provider Demographics
NPI:1912992868
Name:ROGERS, LAURA ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ELIZABETH
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 1:307 ANNUNCIATION ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6044
Mailing Address - Country:US
Mailing Address - Phone:337-280-5741
Mailing Address - Fax:
Practice Address - Street 1:2130 KALISTE SALOOM RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6143
Practice Address - Country:US
Practice Address - Phone:337-981-5466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD200184207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1057258Medicaid
LAP00980759OtherMEDICARE RR
LA4J898CN33Medicare PIN
LAI40479Medicare UPIN
LAP00980759OtherMEDICARE RR