Provider Demographics
NPI:1770510513
Name:ROGERS, DAVID E (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:ROGERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:E
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD A PROFESSIONAL C
Mailing Address - Street 1:222 W. EULALIA STREET
Mailing Address - Street 2:SUITE 309
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204
Mailing Address - Country:US
Mailing Address - Phone:818-243-0499
Mailing Address - Fax:818-243-0280
Practice Address - Street 1:222 W. EULALIA STREET
Practice Address - Street 2:SUITE 309
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204
Practice Address - Country:US
Practice Address - Phone:818-243-0499
Practice Address - Fax:818-243-0280
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60456174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1770510513Medicare UPIN
6225730001Medicare NSC
CAH03442Medicare UPIN