MEDICARE: DR. JAMES RICHARD ROGAN II 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	207Q00000X	Family Medicine Physician	01040713	IN
2	207Q00000X	Family Medicine Physician	01040713A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275616633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES RICHARD ROGAN II MD

Provider Business Mailing Address
First Line	:	8475 DAUBY LANE
Second Line	:
City	:	TELL CITY
State	:	IN
Zip	:	47586-8346
Country	:	US
Telephone Number	:	812-547-1377
Fax Number	:	812-547-3695

Provider Business Practice Location Address
First Line	:	8475 DAUBY LANE
Second Line	:
City	:	TELL CITY
State	:	IN
Zip	:	47586-8346
Country	:	US
Telephone Number	:	812-547-1377
Fax Number	:	812-547-3695

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

Provider Enumeration Date	:	10/21/2006
Last Update Date	:	03/07/2023

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