Healthcare Provider Details

I. General information

NPI: 1992064323
Provider Name (Legal Business Name): ANDREW PHILLIPS ROGERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2012
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2102 IDAHO STREET
ELKO NV
89801
US

IV. Provider business mailing address

2102 IDAHO ST
ELKO NV
89801-2625
US

V. Phone/Fax

Practice location:
  • Phone: 775-389-5777
  • Fax:
Mailing address:
  • Phone: 214-458-9132
  • Fax: 775-360-3602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number62361
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: