MEDICARE: BRIAN C ROGERS MD, INC

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
1	207L00000X	Anesthesiology Physician	G30212	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578557039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN C ROGERS MD, INC

Provider Business Mailing Address
First Line	:	PO BOX 4030
Second Line	:
City	:	FULLERTON
State	:	CA
Zip	:	92834-4030
Country	:	US
Telephone Number	:	714-992-4444
Fax Number	:	714-879-9999

Provider Business Practice Location Address
First Line	:	361 HOSPITAL RD STE 124
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-3521
Country	:	US
Telephone Number	:	949-631-0988
Fax Number	:	949-631-2504

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	01/29/2008

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Directions to “ BRIAN C ROGERS MD, INC” Practice Location

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