Healthcare Provider Details

I. General information

NPI: 1932404001
Provider Name (Legal Business Name): MALCOLM DENNISON ROGERS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MALCOLM DENNISON ROGERS RRT

II. Dates (important events)

Enumeration Date: 01/20/2011
Last Update Date: 01/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 HOSPITAL PL
SOLDOTNA AK
99669-7559
US

IV. Provider business mailing address

PO BOX 257
SOLDOTNA AK
99669-0257
US

V. Phone/Fax

Practice location:
  • Phone: 907-714-4437
  • Fax:
Mailing address:
  • Phone: 907-398-2185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: