Provider Demographics
NPI:1225074545
Name:ROGERS, PETER JONATHAN (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:JONATHAN
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 1:530 VIA ESTRADA UNIT N
Mailing Address - Street 2:
Mailing Address - City:LAGUNA WOODS
Mailing Address - State:CA
Mailing Address - Zip Code:92637-4033
Mailing Address - Country:US
Mailing Address - Phone:949-236-9533
Mailing Address - Fax:
Practice Address - Street 1:19900 MACARTHUR BLVD STE 800
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-8423
Practice Address - Country:US
Practice Address - Phone:877-693-6266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA47822208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF93629Medicare UPIN