Healthcare Provider Details

I. General information

NPI: 1659972560
Provider Name (Legal Business Name): JACOB ROGERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 DAGGETT AVE STE 100
KLAMATH FALLS OR
97601-1130
US

IV. Provider business mailing address

2821 DAGGETT AVE STE 100
KLAMATH FALLS OR
97601-1130
US

V. Phone/Fax

Practice location:
  • Phone: 541-274-6733
  • Fax:
Mailing address:
  • Phone: 541-274-6733
  • Fax: 541-274-2006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD224609
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: