=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912685371
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMBER ROGERS, MD, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2023
-----------------------------------------------------
Last Update Date | 07/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 928 LIPSCOMB ST STE 100
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76104-3171
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-367-0703
-----------------------------------------------------
Fax | 682-990-2594
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 928 LIPSCOMB ST STE 100
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76104-3171
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-367-0703
-----------------------------------------------------
Fax | 682-990-2594
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN, OWNER
-----------------------------------------------------
Name | AMBER RACHELLE ROGERS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 682-367-0703
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------