Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 101345 | MO |
N | 111NI0900X | Internist | 101345 | MO |
Y | 208000000X | Pediatrician | 101345 | MO |
NPI | 1003871039 |
---|---|
Provider Name | Brenda J Rogers |
First Address | Kansas City, MO 64108-4619 |
Second Address | Kansas City, MO 64108-4619 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2006 |
Last Update Date | 03/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
207648601 | (05) | MO |
F85812 | (02) | MO |