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General NPI Number Information
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NPI Number | 1669551636
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Entity Type | Organization
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Legal Business Name | VANCE D. RODGERS, M.D., INC.
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1551 BISHOP ST SUITE 230
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-4635
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Country | US
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Telephone | 805-786-4563
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Fax | 805-786-4220
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Provider Business Mailing Address
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Address Line | 1551 BISHOP ST SUITE 230
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-4635
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Country | US
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Telephone | 805-786-4563
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Fax | 805-786-4220
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MRS. VIRGINIA ANN RODGERS
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Credential |
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Telephone | 805-786-4240
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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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