Provider Demographics
NPI:1124867759
Name:ROGERS, BRANDON S (MD)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:S
Last Name:ROGERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2370 VICTORY AVE APT 1007
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-7917
Mailing Address - Country:US
Mailing Address - Phone:951-809-0840
Mailing Address - Fax:
Practice Address - Street 1:110 MEMORIAL HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-4940
Practice Address - Country:US
Practice Address - Phone:936-291-4204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program