Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | G84249 | CA |
NPI | 1205896370 |
---|---|
Provider Name | Christopher J Rogers |
First Address | Carlsbad, CA 92011-1113 |
Second Address | Carlsbad, CA 92011-1113 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 25/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
92056B018 | CHAMPUS (01) | CA |
CP8020 | MEDICARE RAILROAD GROUP # (01) | CA |
G48314 | (02) | CA |
ZZZ72841Z | (05) | CA |