Provider Demographics
NPI:1033153036
Name:ROGERS, WILLIAM A (PA C)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:A
Last Name:ROGERS
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 218
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:OK
Mailing Address - Zip Code:74016-0218
Mailing Address - Country:US
Mailing Address - Phone:918-855-3737
Mailing Address - Fax:918-341-8139
Practice Address - Street 1:206 E BLUE STARR DR
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-4223
Practice Address - Country:US
Practice Address - Phone:918-341-8100
Practice Address - Fax:918-341-8139
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2021-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1737363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200193550AMedicaid
OK200193550AMedicaid
OK400534Medicare PIN