=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841371572
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. PHILO A ROGERS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2006
-----------------------------------------------------
Last Update Date | 03/09/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 250 W CHANDLER HEIGHTS RD STE 300
-----------------------------------------------------
City | CHANDLER
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85248-5055
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-755-0800
-----------------------------------------------------
Fax | 602-560-2721
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 24981
-----------------------------------------------------
City | BELFAST
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04915-2000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 844-969-0686
-----------------------------------------------------
Fax | 773-832-7083
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 2809
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------