Provider Demographics
NPI:1669510160
Name:ROGERS, ROBERT LYLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LYLE
Last Name:ROGERS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3805 ASHFORD DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-1247
Mailing Address - Country:US
Mailing Address - Phone:541-345-1002
Mailing Address - Fax:
Practice Address - Street 1:180 28TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-5135
Practice Address - Country:US
Practice Address - Phone:541-221-1424
Practice Address - Fax:541-746-7097
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health