MEDICARE: CHARLES CRAIG ROGERS P.A.

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	PA06973	TX

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

General Provider Information

NPI Number	:	1669781720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES CRAIG ROGERS P.A.

Provider Business Mailing Address
First Line	:	8030 N LOOP DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79915-3226
Country	:	US
Telephone Number	:	915-591-2704
Fax Number	:	915-598-3946

Provider Business Practice Location Address
First Line	:	6974 GATEWAY BLVD E
Second Line	:	STE F
City	:	EL PASO
State	:	TX
Zip	:	79915-1115
Country	:	US
Telephone Number	:	915-774-8850
Fax Number	:	915-598-3946

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

Provider Enumeration Date	:	10/06/2010
Last Update Date	:	05/25/2011

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