Provider Demographics
NPI:1578797882
Name:PAUL ROGERS MD
Entity Type:Organization
Organization Name:PAUL ROGERS MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-635-7325
Mailing Address - Street 1:224 RAILROAD ST.
Mailing Address - Street 2:
Mailing Address - City:JOHNSON
Mailing Address - State:VT
Mailing Address - Zip Code:05656
Mailing Address - Country:US
Mailing Address - Phone:802-635-7325
Mailing Address - Fax:802-635-9825
Practice Address - Street 1:224 RAILROAD ST.
Practice Address - Street 2:
Practice Address - City:JOHNSON
Practice Address - State:VT
Practice Address - Zip Code:05656
Practice Address - Country:US
Practice Address - Phone:802-635-7325
Practice Address - Fax:802-635-9825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0006199363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty