Healthcare Provider Details

I. General information

NPI: 1295717163
Provider Name (Legal Business Name): JASON H. ROGERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 09/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 Y ST SUITE 2820
SACRAMENTO CA
95817-2307
US

IV. Provider business mailing address

4860 Y ST SUITE 2820
SACRAMENTO CA
95817-2307
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-3764
  • Fax: 916-734-8394
Mailing address:
  • Phone: 916-734-3764
  • Fax: 916-734-8394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA82748
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberA82748
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: