Healthcare Provider Details

I. General information

NPI: 1427151539
Provider Name (Legal Business Name): BETH S ROGERS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 E MONTVUE DR STE 100
MERIDIAN ID
83642-6318
US

IV. Provider business mailing address

1779 W MARTEN CREEK DR
MERIDIAN ID
83642-3295
US

V. Phone/Fax

Practice location:
  • Phone: 208-855-2900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberM9667
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: