Healthcare Provider Details

I. General information

NPI: 1255887840
Provider Name (Legal Business Name): KORY ROGERS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 03/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5512 BELLAIRE DR S STE K
FORT WORTH TX
76109-5800
US

IV. Provider business mailing address

215 SHUMAN BLVD STE 401
NAPERVILLE IL
60563-8123
US

V. Phone/Fax

Practice location:
  • Phone: 817-546-0514
  • Fax: 817-546-0518
Mailing address:
  • Phone: 630-303-5380
  • Fax: 630-303-5385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number80611
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: