Provider Demographics
NPI:1942547286
Name:ROGERS, JONATHAN L
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:L
Last Name:ROGERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 GAY PL
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-5132
Mailing Address - Country:US
Mailing Address - Phone:501-613-7575
Mailing Address - Fax:501-251-1094
Practice Address - Street 1:7 GAY PL
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-5132
Practice Address - Country:US
Practice Address - Phone:501-613-7575
Practice Address - Fax:501-251-1094
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR0302200813171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications