Provider Demographics
NPI:1669553509
Name:ROGERS, AUDREY L (MD)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:L
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 99213
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0213
Mailing Address - Country:US
Mailing Address - Phone:682-885-1860
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:13340 HIGHLAND HILLS DR STE 111
Practice Address - Street 2:
Practice Address - City:ALEDO
Practice Address - State:TX
Practice Address - Zip Code:76008-2000
Practice Address - Country:US
Practice Address - Phone:682-303-3000
Practice Address - Fax:682-303-3025
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2735208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U87ZOtherBCBSTX GRP PIN
TX86W591OtherBCBSTX IND PIN
TX1640304OtherFIRSTHEALTH PIN
1750369203OtherGRP NPI NUMBER
TX2912917OtherCIGNA PIN
TX115132607Medicaid
TX177056201Medicaid
TXROGAE46798OtherCCHIP PIN
TX749604OtherUHC PIN
TX137345801Medicaid
TX4138977OtherAETNA PIN
TXROGAE46798OtherCCHIP PIN
TX86W591OtherBCBSTX IND PIN
TX115132607Medicaid
TX00740ZMedicare PIN