Healthcare Provider Details

I. General information

NPI: 1295129179
Provider Name (Legal Business Name): LAURETHA UZOAMAKA ROGERS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURETHA UZOAMAKA UGOKWE

II. Dates (important events)

Enumeration Date: 03/27/2015
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W MAPLE ST
FARMINGTON NM
87401-5630
US

IV. Provider business mailing address

PO BOX 844088
DALLAS TX
75284-4088
US

V. Phone/Fax

Practice location:
  • Phone: 505-609-6772
  • Fax: 505-609-6474
Mailing address:
  • Phone: 505-609-2258
  • Fax: 505-609-2259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD2019-0860
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number59814
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD-46316
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number28380
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: