Healthcare Provider Details

I. General information

NPI: 1821178245
Provider Name (Legal Business Name): JOHN ROGERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 11/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 E 19TH ST STE 100
THE DALLES OR
97058-3392
US

IV. Provider business mailing address

1935 E 19TH ST STE 100 PO BOX 1520
THE DALLES OR
97058-3392
US

V. Phone/Fax

Practice location:
  • Phone: 541-296-7677
  • Fax: 541-296-7206
Mailing address:
  • Phone: 541-296-7677
  • Fax: 541-296-7206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH3742
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD150489
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: