Healthcare Provider Details

I. General information

NPI: 1669506630
Provider Name (Legal Business Name): NICOLE ELAINE ROGERS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 10/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 GALLERIA DR STE 201
METAIRIE LA
70001-2196
US

IV. Provider business mailing address

3100 GALLERIA DR STE 201
METAIRIE LA
70001-2196
US

V. Phone/Fax

Practice location:
  • Phone: 504-315-4247
  • Fax: 210-444-2034
Mailing address:
  • Phone: 941-286-0169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number15703R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: