Healthcare Provider Details

I. General information

NPI: 1477472298
Provider Name (Legal Business Name): JACOB STEPHEN ROGERS FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2808 PARK AVE STE C
MERCED CA
95348-3392
US

IV. Provider business mailing address

3293 MARINER CT
ATWATER CA
95301-2294
US

V. Phone/Fax

Practice location:
  • Phone: 209-500-3050
  • Fax:
Mailing address:
  • Phone: 209-325-6975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number95040110
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: