Provider Demographics
NPI:1992889661
Name:ROGERS, JOHN T JR (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:ROGERS
Suffix:JR
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:PO BOX 99371
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0371
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-7347
Practice Address - Street 1:3200 RIVERFRONT DR
Practice Address - Street 2:STE 103
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-6570
Practice Address - Country:US
Practice Address - Phone:817-336-3800
Practice Address - Fax:817-335-9454
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC8425208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
1750369203OtherGRP NPI NUMBER
TX177056201Medicaid
TX177056202Medicaid
TX86W590OtherBCBSTX IND PIN
TXROGTE86089OtherCCHIP PIN
TX00U87ZOtherBCBSTX GRP IPN
TX137345801Medicaid
TX4317664OtherAETNA PIN
TX123250605Medicaid
TX697562OtherFIRSTHEALTH PIN
TX123250604Medicaid
TX133997OtherUHC PIN
TX2877658OtherFIRSTCARE PIN
TX123250605Medicaid
TXROGTE86089OtherCCHIP PIN
TX00740ZMedicare PIN
TX4317664OtherAETNA PIN
TX8F1577Medicare PIN