Healthcare Provider Details

I. General information

NPI: 1093912693
Provider Name (Legal Business Name): AIMEE ELISE ROGERS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 02/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 ST ANTHONY WAY
PENDLETON OR
97801
US

IV. Provider business mailing address

2801 ST ANTHONY WAY
PENDLETON OR
97801-3800
US

V. Phone/Fax

Practice location:
  • Phone: 541-278-0535
  • Fax: 541-966-0574
Mailing address:
  • Phone: 541-966-0535
  • Fax: 541-966-0574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number01072434A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License Number01072434A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD179156
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: