Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | F4444 | TX |
N | 207KA0200X | Allergist | F4444 | TX |
N | 2080P0201X | Pediatric Allergist | F4444 | TX |
NPI | 1619970969 |
---|---|
Provider Name | Dr. Robert J. Rogers |
First Address | Fort Worth, TX 76107-5029 |
Second Address | Fort Worth, TX 76107-5029 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2005 |
Last Update Date | 24/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
033448401 | (05) | TX |
C21229 | (02) | TX |