Healthcare Provider Details

I. General information

NPI: 1285641530
Provider Name (Legal Business Name): JARED ROGERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 W CHESTNUT ST
BLOOMINGTON IL
61701-2814
US

IV. Provider business mailing address

1003 MARTIN LUTHER KING DR
BLOOMINGTON IL
61701-1429
US

V. Phone/Fax

Practice location:
  • Phone: 309-557-1400
  • Fax: 309-557-1461
Mailing address:
  • Phone: 888-924-3786
  • Fax: 309-820-3574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036084031
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: