Individual
TRACY EDWARD ROGERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
202 CONWAY DR STE 200, KALISPELL, MT 59901-3153
(406) 751-4189
(406) 751-4145
Mailing address
202 CONWAY DR STE 200, KALISPELL, MT 59901-3153
(406) 751-4189
(406) 751-4145
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
441
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000097043
BLUE CROSS
MT
05
—
4307613
—
MT
Enumeration date
08/31/2006
Last updated
01/11/2017
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