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General NPI Number Information
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NPI Number | 1215017744
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Entity Type | Individual
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Provider Name | GLENN ALVIN ROGERS MD
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Gender | Male
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 04/18/2011
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Provider Practice Location Address
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Address Line | 12459 US 22 AND 3
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City | SABINA
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State | OH
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Zip | 45169
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Country | US
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Telephone | 937-584-2459
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Fax | 937-584-4941
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Provider Business Mailing Address
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Address Line | 12459 US 22 AND 3
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City | SABINA
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State | OH
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Zip | 45169
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Country | US
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Telephone | 937-584-2459
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Fax | 937-584-4941
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 35076945R
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License Number State | OH
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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 | 35076945
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License Number State | OH
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