Healthcare Provider Details

I. General information

NPI: 1114295441
Provider Name (Legal Business Name): JOSEPH C. ROGERS CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2011
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 ELMER J BISSELL RD
BIRMINGHAM AL
35243-2941
US

IV. Provider business mailing address

1940 ELMER J BISSELL RD
BIRMINGHAM AL
35243-2941
US

V. Phone/Fax

Practice location:
  • Phone: 205-824-4949
  • Fax:
Mailing address:
  • Phone: 205-824-4949
  • Fax: 205-824-4983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-102052
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: