Healthcare Provider Details

I. General information

NPI: 1073519252
Provider Name (Legal Business Name): LEO F ROGERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 FOUNTAIN CT STE 120
LEXINGTON KY
40509-2695
US

IV. Provider business mailing address

PO BOX 936
LONDON KY
40743-0936
US

V. Phone/Fax

Practice location:
  • Phone: 859-629-7245
  • Fax: 859-629-7246
Mailing address:
  • Phone:
  • Fax: 606-330-7825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17364
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: