Healthcare Provider Details

I. General information

NPI: 1770699829
Provider Name (Legal Business Name): JEFFREY S ROGERS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 LITTLE YORK ROAD SUITE 10
DAYTON OH
45414-5803
US

IV. Provider business mailing address

PO BOX 713130
CINCINNATI OH
45271-0001
US

V. Phone/Fax

Practice location:
  • Phone: 937-415-9100
  • Fax: 937-415-9191
Mailing address:
  • Phone: 937-415-9100
  • Fax: 937-415-9191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number34006038
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number34006038
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: