Basic Information
Provider Information | |||||||||
NPI: | 1093912693 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ROGERS | ||||||||
FirstName: | AIMEE | ||||||||
MiddleName: | ELISE | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2801 ST ANTHONY WAY | ||||||||
Address2: |   | ||||||||
City: | PENDLETON | ||||||||
State: | OR | ||||||||
PostalCode: | 978013800 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5419660535 | ||||||||
FaxNumber: | 5419660574 | ||||||||
Practice Location | |||||||||
Address1: | 3001 ST ANTHONY WAY | ||||||||
Address2: |   | ||||||||
City: | PENDLETON | ||||||||
State: | OR | ||||||||
PostalCode: | 97801 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5412780535 | ||||||||
FaxNumber: | 5419660574 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/28/2007 | ||||||||
LastUpdateDate: | 02/21/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 01072434A | IN | N |   | Allopathic & Osteopathic Physicians | Urology |   | 2088F0040X | 01072434A | IN | N |   | Allopathic & Osteopathic Physicians | Urology | Female Pelvic Medicine and Reconstructive Surgery | 208800000X | MD179156 | OR | Y |   | Allopathic & Osteopathic Physicians | Urology |   |
ID Information
ID | Type | State | Issuer | Description | 000000814023 | 01 | IN | ANTHEM | OTHER | 201149850 | 05 | IN |   | MEDICAID | 500719528 | 05 | OR |   | MEDICAID |