Healthcare Provider Details

I. General information

NPI: 1629982574
Provider Name (Legal Business Name): SAMUEL ROGERS JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1926 S FEDERAL BLVD STE 108
DENVER CO
80219-5501
US

IV. Provider business mailing address

1275 SANTA FE DR UNIT 429
DENVER CO
80204-3778
US

V. Phone/Fax

Practice location:
  • Phone: 719-247-8872
  • Fax:
Mailing address:
  • Phone: 983-218-2490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: