Basic Information
Provider Information
NPI: 1003015785
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROGERS
FirstName: RYAN
MiddleName: W.
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1315 ST JOSEPH PKWY
Address2: SUITE 1205
City: HOUSTON
State: TX
PostalCode: 770028233
CountryCode: US
TelephoneNumber: 7136593937
FaxNumber: 7136592553
Practice Location
Address1: 1315 ST JOSEPH PKWY
Address2: SUITE 1205
City: HOUSTON
State: TX
PostalCode: 770028233
CountryCode: US
TelephoneNumber: 7136593937
FaxNumber: 7136592553
Other Information
ProviderEnumerationDate: 07/13/2007
LastUpdateDate: 02/29/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207W00000XMD2010-0725NMY Allopathic & Osteopathic PhysiciansOphthalmology 

ID Information
IDTypeStateIssuerDescription
18883640105TX MEDICAID
8J852401TXMEDICARE/EASTOTHER
18883640301TXMEDICAID/EASTOTHER
8J852301TXMEDICARE/MP1OTHER


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