Basic Information
| Provider Information | |||||||||
| NPI: | 1720197817 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROGERS | ||||||||
| FirstName: | P | ||||||||
| MiddleName: | BRIAN | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1727 W COLLEGE ST | ||||||||
| Address2: | |||||||||
| City: | BOZEMAN | ||||||||
| State: | MT | ||||||||
| PostalCode: | 597154913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4065874432 | ||||||||
| FaxNumber: | 4065877015 | ||||||||
| Practice Location | |||||||||
| Address1: | 1727 W COLLEGE ST | ||||||||
| Address2: | |||||||||
| City: | BOZEMAN | ||||||||
| State: | MT | ||||||||
| PostalCode: | 597154913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4065874432 | ||||||||
| FaxNumber: | 4065877015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 10/28/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 3774 | MT | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.