Provider Demographics
NPI:1982993374
Name:ROGERS, MEGAN OLSON
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:OLSON
Last Name:ROGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6230 CULVER DR SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97317-9241
Mailing Address - Country:US
Mailing Address - Phone:503-580-5435
Mailing Address - Fax:
Practice Address - Street 1:3900 FIFTH AVE STE 110
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3122
Practice Address - Country:US
Practice Address - Phone:858-554-1212
Practice Address - Fax:858-554-1222
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA122784207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty