Healthcare Provider Details

I. General information

NPI: 1982633475
Provider Name (Legal Business Name): ROBERT MANNING ROGERS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 11/27/2023
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 CLAREMONT ST
KALISPELL MT
59901-3585
US

IV. Provider business mailing address

307 BLANCHARD HOLW
WHITEFISH MT
59937-8253
US

V. Phone/Fax

Practice location:
  • Phone: 406-752-8282
  • Fax: 406-257-2225
Mailing address:
  • Phone: 406-752-8282
  • Fax: 406-257-2225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number10632
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: