Provider Demographics
NPI:1689613382
Name:ROGERS, CHESTER LYNN (MD)
Entity Type:Individual
Prefix:
First Name:CHESTER
Middle Name:LYNN
Last Name:ROGERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 E CEDAR ST
Mailing Address - Street 2:STE 200
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2057
Mailing Address - Country:US
Mailing Address - Phone:574-472-6700
Mailing Address - Fax:574-472-6746
Practice Address - Street 1:114 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BOURBON
Practice Address - State:IN
Practice Address - Zip Code:46504-1623
Practice Address - Country:US
Practice Address - Phone:574-342-2444
Practice Address - Fax:574-342-2442
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01041632207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000803855OtherANTHEM
IN000001417982OtherANTHEM
IN100328410Medicaid
IN000001418073OtherANTHEM
IN000000314564OtherANTHEM
IN000000878019OtherANTHEM
IN000001418170OtherANTHEM
IN000001417024OtherANTHEM
IN000000314564OtherBCBS
IN000001418134OtherANTHEM