Basic Information
| Provider Information | |||||||||
| NPI: | 1598900995 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROGERS | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | THERESE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2200 NE PROFESSIONAL CT | ||||||||
| Address2: | |||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977016063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413896313 | ||||||||
| FaxNumber: | 5413898760 | ||||||||
| Practice Location | |||||||||
| Address1: | 2200 NE PROFESSIONAL CT | ||||||||
| Address2: | |||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977016063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413896313 | ||||||||
| FaxNumber: | 5413898760 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2008 | ||||||||
| LastUpdateDate: | 08/23/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD152194 | OR | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.