Provider Demographics
NPI:1396060281
Name:ROGERS, PETER HAWLEY III (DO)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:HAWLEY
Last Name:ROGERS
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:BUDDY
Other - Middle Name:HAWLEY
Other - Last Name:ROGERS
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:14401 WESTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-1700
Mailing Address - Country:US
Mailing Address - Phone:612-599-4952
Mailing Address - Fax:
Practice Address - Street 1:13688 ROGERS DR
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:MN
Practice Address - Zip Code:55374-4916
Practice Address - Country:US
Practice Address - Phone:952-977-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-02
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN57882207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics