MEDICARE: JASON ROGERS PA

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	363A00000X	Physician Assistant	0005936	CO
2	363A00000X	Physician Assistant	54044	CA
3	363A00000X	Physician Assistant	9109950	FL

General Provider Information

NPI Number	:	1306380266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON ROGERS PA

Provider Business Mailing Address
First Line	:	1720 KIRKWOOD DR APT N29
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-2027
Country	:	US
Telephone Number	:	970-632-0135
Fax Number	:

Provider Business Practice Location Address
First Line	:	313 W DRAKE RD
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-2846
Country	:	US
Telephone Number	:	970-632-0135
Fax Number	:

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

Provider Enumeration Date	:	12/12/2016
Last Update Date	:	02/06/2023

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Directions to “ JASON ROGERS PA” Practice Location

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