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NPI Code Detail

MEDICARE: DR. RANDALL W RODGERS D.O.

MEDICARE: DR. RANDALL W RODGERS D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208VP0014XInterventional Pain Medicine PhysicianG0020TX
2207Q00000XFamily Medicine PhysicianG0020TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00342603OTHERTXRAILROAD MEDICARE
6663166OTHERTXSTERLING MEDICARE ADVANTAGE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18V0490OTHERTXBCBSTX
343848OTHERTXSTERLING
41104852888OTHERTXBCBSTX
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1104852888
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RANDALL W RODGERS D.O.
Provider Business Mailing Address
First Line : 403 STATE HIGHWAY 110 N
Second Line :
City : WHITEHOUSE
State : TX
Zip : 75791-3109
Country : US
Telephone Number : 903-839-1000
Fax Number : 903-839-4000
Provider Business Practice Location Address
First Line : 403 STATE HIGHWAY 110 N
Second Line :
City : WHITEHOUSE
State : TX
Zip : 75791-3109
Country : US
Telephone Number : 903-839-1000
Fax Number : 903-839-4000
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2006
Last Update Date : 09/10/2015

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Directions to “ DR. RANDALL W RODGERS D.O.” Practice Location

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