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General NPI Number Information
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NPI Number | 1902895170
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Entity Type | Individual
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Provider Name | BRENDA A ROGERS-GRAYS DO
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Gender | Female
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Dates
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Enumeration Date | 10/19/2005
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Last Update Date | 04/19/2021
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Provider Practice Location Address
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Address Line | 1134 S LINDEN RD STE 6 BLDG C
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City | FLINT
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State | MI
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Zip | 48532-3455
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Country | US
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Telephone | 810-732-5555
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Fax | 810-732-1155
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Provider Business Mailing Address
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Address Line | 1134 S LINDEN RD STE 6 BLDG C
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City | FLINT
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State | MI
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Zip | 48532-3455
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Country | US
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Telephone | 810-732-5555
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Fax | 810-732-1155
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101008664
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License Number State | MI
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