Healthcare Provider Details

I. General information

NPI: 1871090647
Provider Name (Legal Business Name): JONATHON ROGERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 N ELM ST STE 204
HENDERSON KY
42420-2773
US

IV. Provider business mailing address

PO BOX 638706
CINCINNATI OH
45263-8706
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-4953
  • Fax:
Mailing address:
  • Phone: 812-450-6815
  • Fax: 812-450-6822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberTP661
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: