Healthcare Provider Details

I. General information

NPI: 1689622938
Provider Name (Legal Business Name): JOHN D. ROGERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 12/06/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 HOSPITAL DRIVE HANNIBAL REGIONAL HOSPITAL
HANNIBAL MO
63401
US

IV. Provider business mailing address

10540 MARTY ST STE 100
OVERLAND PARK KS
66212-2551
US

V. Phone/Fax

Practice location:
  • Phone: 573-629-3342
  • Fax: 573-629-3432
Mailing address:
  • Phone: 913-660-1616
  • Fax: 913-660-1664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number04-32632
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2012023084
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: