Provider Demographics
NPI:1275616633
Name:ROGAN, JAMES RICHARD II (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RICHARD
Last Name:ROGAN
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8475 DAUBY LANE
Mailing Address - Street 2:
Mailing Address - City:TELL CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47586-8346
Mailing Address - Country:US
Mailing Address - Phone:812-547-1377
Mailing Address - Fax:812-547-3695
Practice Address - Street 1:8475 DAUBY LANE
Practice Address - Street 2:
Practice Address - City:TELL CITY
Practice Address - State:IN
Practice Address - Zip Code:47586-8346
Practice Address - Country:US
Practice Address - Phone:812-547-1377
Practice Address - Fax:812-547-3695
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040713207Q00000X
IN01040713A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200502720AMedicaid
IN100323030Medicaid
IN100323030Medicaid
IN100323030Medicaid
F36667Medicare UPIN
IN200502720AMedicaid