Provider Demographics
NPI:1992779110
Name:RODGERS, MELVIN ERIC (FNP, PHD)
Entity type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:ERIC
Last Name:RODGERS
Suffix:
Gender:M
Credentials:FNP, PHD
Other - Prefix:DR
Other - First Name:M.
Other - Middle Name:ERIC
Other - Last Name:RODGERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP, PHD
Mailing Address - Street 1:1055 CLERMONT ST
Mailing Address - Street 2:MAILSTOP 118
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-3808
Mailing Address - Country:US
Mailing Address - Phone:303-393-2859
Mailing Address - Fax:303-393-4687
Practice Address - Street 1:1055 CLERMONT ST
Practice Address - Street 2:MAILSTOP 118
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3808
Practice Address - Country:US
Practice Address - Phone:303-393-2859
Practice Address - Fax:303-393-4687
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO71359363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily