MEDICARE: MR. MICHAEL F RODGERS LVN

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	164X00000X	Licensed Vocational Nurse	160713	TX

General Provider Information

NPI Number	:	1619151107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL F RODGERS LVN

Provider Business Mailing Address
First Line	:	1282 BOYT RD
Second Line	:
City	:	CRYSTAL BEACH
State	:	TX
Zip	:	77650-2033
Country	:	US
Telephone Number	:	409-939-0115
Fax Number	:

Provider Business Practice Location Address
First Line	:	1282 BOYT RD
Second Line	:
City	:	CRYSTAL BEACH
State	:	TX
Zip	:	77650-2033
Country	:	US
Telephone Number	:	409-939-0115
Fax Number	:

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

Provider Enumeration Date	:	12/20/2007
Last Update Date	:	12/20/2007

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