Individual
SUNDANCE L ROGERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1344 WINTERGREEN LN NE, BAINBRIDGE ISLAND, WA 98110
(206) 842-5632
(206) 842-5992
Mailing address
1344 WINTERGREEN LN NE, BAINBRIDGE ISLAND, WA 98110-5118
(206) 842-5632
(206) 842-5992
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD00033047
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0039581
LABOR AND INDUSTRIES #
WA
01
—
110217394
RAILROAD MEDICARE
WA
01
—
6701RO
BLUE SHIELD #
WA
05
—
8192486
—
WA
01
—
US0819159
AETNA SPECIALIST PIN
WA
01
—
US0900037
AETNA PCP PIN
WA
Enumeration date
10/02/2006
Last updated
07/02/2018
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