Provider Demographics
NPI:1992064323
Name:ROGERS, ANDREW PHILLIPS (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:PHILLIPS
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 1:2102 IDAHO ST
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-2625
Mailing Address - Country:US
Mailing Address - Phone:214-458-9132
Mailing Address - Fax:775-360-3602
Practice Address - Street 1:2102 IDAHO STREET
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801
Practice Address - Country:US
Practice Address - Phone:775-389-5777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-04
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI62361208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1992064323Medicaid
NVV65514OtherPTAN
NV1992064323Medicaid