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General NPI Number Information
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NPI Number | 1063943587
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Entity Type | Individual
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Provider Name | CODY STARK ROGERS MD
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Gender | Male
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Dates
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Enumeration Date | 03/26/2017
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 2302 COLLEGE AVE
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City | CONWAY
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State | AR
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Zip | 72034-6297
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Country | US
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Telephone | 501-329-3831
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 802843
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City | KANSAS CITY
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State | MO
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Zip | 64180-2843
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Country | US
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Telephone | 417-730-6430
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Fax | 417-269-7567
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | E-18327
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2019003806
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License Number State | MO
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