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NPI Code Detail

MEDICARE: DR. TARA ROGNAN D.O.

MEDICARE: DR. TARA ROGNAN D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician2015019358MO

General Provider Information

NPI Number : 1598147886
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TARA ROGNAN D.O.
Provider Business Mailing Address
First Line : PO BOX 955534
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63195-5534
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 400 MEDICAL PLZ STE 200
Second Line :
City : LAKE ST LOUIS
State : MO
Zip : 63367-1417
Country : US
Telephone Number : 636-625-2662
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2015
Last Update Date : 11/20/2020

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