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General NPI Number Information
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NPI Number | 1427039916
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Entity Type | Individual
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Provider Name | VANCE D RODGERS M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/10/2005
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Last Update Date | 01/23/2020
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Provider Practice Location Address
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Address Line | 1551 BISHOP ST STE 230
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-4661
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Country | US
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Telephone | 805-434-5530
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Fax | 805-786-4220
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Provider Business Mailing Address
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Address Line | 1400 E. CHURCH STREET ATTENTION- MEDICAL STAFF OFFICE
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City | SANTA MARIA
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State | CA
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Zip | 93454
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Country | US
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Telephone | 805-739-3954
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Fax | 805-739-3060
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | G44433
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License Number State | CA
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