Provider Demographics
NPI:1215225412
Name:ROGERS, ROXANNE B (DO)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:B
Last Name:ROGERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 PIERCE ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-4669
Mailing Address - Country:US
Mailing Address - Phone:419-557-5568
Mailing Address - Fax:419-557-5568
Practice Address - Street 1:348 MILAN AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-1173
Practice Address - Country:US
Practice Address - Phone:419-668-4567
Practice Address - Fax:419-668-4568
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH34011516207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0110689Medicaid
$$$$$$$$$-00OtherBWC
OHH378590Medicare PIN