Healthcare Provider Details

I. General information

NPI: 1902895170
Provider Name (Legal Business Name): BRENDA A ROGERS-GRAYS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1134 S LINDEN RD STE 6 BLDG C
FLINT MI
48532-3455
US

IV. Provider business mailing address

1134 S LINDEN RD STE 6 BLDG C
FLINT MI
48532-3455
US

V. Phone/Fax

Practice location:
  • Phone: 810-732-5555
  • Fax: 810-732-1155
Mailing address:
  • Phone: 810-732-5555
  • Fax: 810-732-1155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101008664
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: