Healthcare Provider Details

I. General information

NPI: 1700816238
Provider Name (Legal Business Name): GREGORY A ROGERS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 C TREE RD
MCALESTER OK
74501-9002
US

IV. Provider business mailing address

1 C TREE RD
MCALESTER OK
74501-9002
US

V. Phone/Fax

Practice location:
  • Phone: 918-420-6495
  • Fax: 918-420-7497
Mailing address:
  • Phone: 918-420-6495
  • Fax: 918-420-7497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number2434
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: