Healthcare Provider Details

I. General information

NPI: 1164636171
Provider Name (Legal Business Name): BRIAN JAMES ROGERS R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 NORTHWEST DIAMOND LAKE BOULEVARD
ROSEBURG OR
97470
US

IV. Provider business mailing address

7788 HIGHWAY 138 W
OAKLAND OR
97462-9775
US

V. Phone/Fax

Practice location:
  • Phone: 541-440-1000
  • Fax: 541-677-0389
Mailing address:
  • Phone: 541-440-1000
  • Fax: 541-677-0389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: