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General NPI Number Information
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NPI Number | 1306578414
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Entity Type | Individual
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Provider Name | ZETH THOMAS ROGERS PA-C
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Gender | Male
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Dates
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Enumeration Date | 06/28/2022
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Last Update Date | 01/31/2024
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Provider Practice Location Address
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Address Line | 1013 GRANITE DR
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City | BARDSTOWN
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State | KY
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Zip | 40004-2013
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Country | US
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Telephone | 502-349-3100
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Fax | 502-349-3169
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Provider Business Mailing Address
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Address Line | 101 R MILLS RD
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City | GREENSBURG
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State | KY
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Zip | 42743-8329
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Country | US
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Telephone | 270-405-0689
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA3043
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License Number State | KY
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