Healthcare Provider Details

I. General information

NPI: 1619041415
Provider Name (Legal Business Name): WILLIAM RANDOLPH ROGERS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 STAGECOACH TRL SUITE 200
SAN MARCOS TX
78666-5134
US

IV. Provider business mailing address

134 E SIERRA CIR
SAN MARCOS TX
78666-2534
US

V. Phone/Fax

Practice location:
  • Phone: 512-396-4700
  • Fax: 512-396-4796
Mailing address:
  • Phone: 512-396-3963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberE5912
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: