Provider Demographics
NPI:1568443679
Name:ROGERS, RANDALL SCOT (MD)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:SCOT
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 1:2600 W BARD RANCH RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-7783
Mailing Address - Country:US
Mailing Address - Phone:928-778-9366
Mailing Address - Fax:
Practice Address - Street 1:2000 W BETHANY HOME RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2443
Practice Address - Country:US
Practice Address - Phone:602-249-0212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11583207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAW1436OtherHEALTHNET GRP
AZ39 81220OtherEVERCARE GRP
AZ295586Medicaid
AZ86 0373636OtherHUMANA GROUP
AZ453051001OtherGROUP HEALTH GRP
AZAZ0728670OtherBLUE CROSS BLUE SHIELD GR
AZ453051001OtherGROUP HEALTH GRP
AZ39 81220OtherEVERCARE GRP