Provider Demographics
NPI:1821178245
Name:ROGERS, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
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 1:1935 E 19TH ST STE 100
Mailing Address - Street 2:PO BOX 1520
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-3392
Mailing Address - Country:US
Mailing Address - Phone:541-296-7677
Mailing Address - Fax:541-296-7206
Practice Address - Street 1:1935 E 19TH ST STE 100
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-3392
Practice Address - Country:US
Practice Address - Phone:541-296-7677
Practice Address - Fax:541-296-7206
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3742207Q00000X
ORMD150489207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126487102Medicaid
OR500632165Medicaid
OR388506Medicare Oscar/Certification
OR500632165Medicaid
D19756Medicare UPIN
TX126487102Medicaid