Provider Demographics
NPI:1518020304
Name:ROGERS, GENE (MD)
Entity type:Individual
Prefix:DR
First Name:GENE
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 1:11431 GOLD COUNTRY BLVD
Mailing Address - Street 2:
Mailing Address - City:GOLD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7810
Mailing Address - Country:US
Mailing Address - Phone:916-631-8479
Mailing Address - Fax:916-631-8404
Practice Address - Street 1:9616 MICRON AVE
Practice Address - Street 2:850B
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-2625
Practice Address - Country:US
Practice Address - Phone:916-875-9847
Practice Address - Fax:916-875-9833
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC42535171M00000X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171M00000XOther Service ProvidersCase Manager/Care Coordinator
Not Answered207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC42535OtherLICENSE