MEDICARE: JENNIFER J ROGAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	45476	MN

General Provider Information

NPI Number	:	1003815051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER J ROGAN MD

Provider Business Mailing Address
First Line	:	1900 CENTRACARE CIRCLE
Second Line	:	CENTRACARE CLINIC WOMENS & CHILDRENS
City	:	ST CLOUD
State	:	MN
Zip	:	56303
Country	:	US
Telephone Number	:	320-654-3630
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 CENTRACARE CIRCLE
Second Line	:	CENTRACARE CLINIC WOMENS & CHILDRENS
City	:	ST CLOUD
State	:	MN
Zip	:	56303
Country	:	US
Telephone Number	:	320-654-3630
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	07/08/2007

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