Provider Demographics
NPI:1902895170
Name:ROGERS-GRAYS, BRENDA A (DO)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:A
Last Name:ROGERS-GRAYS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1134 S LINDEN RD STE 6 BLDG C
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3455
Mailing Address - Country:US
Mailing Address - Phone:810-732-5555
Mailing Address - Fax:810-732-1155
Practice Address - Street 1:1134 S LINDEN RD STE 6 BLDG C
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3455
Practice Address - Country:US
Practice Address - Phone:810-732-5555
Practice Address - Fax:810-732-1155
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008664207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0852502844OtherBLUE CROSS BLUE SHIELD
MI0852502845OtherHEALTH PLUS
MA4232634001OtherCIGNA
MI204390OtherHEALTH ADVANTAGE NETWORK
MI4073621OtherAETNA
MICD3610/P00064642OtherMETRAHEALTH
MIF00557OtherHEALTH ALLIANCE PLAN
MI080D410020OtherBLUE CARE NETWORK
MI204390OtherMCLAREN HEATLH PLAN
MI4542857Medicaid
MIC2595OtherMCARE
MIF00557OtherHEALTH NET FEDERAL
MI080D410020OtherBLUE CROSS BLUE SHIELD
MI4073621OtherAETNA
MIF00557Medicare UPIN