Provider Demographics
NPI:1457608036
Name:LOCHE, ROGERS WILLIAMS III (MS)
Entity Type:Individual
Prefix:MR
First Name:ROGERS
Middle Name:WILLIAMS
Last Name:LOCHE
Suffix:III
Gender:M
Credentials:MS
Other - Prefix:MR
Other - First Name:ROGERS
Other - Middle Name:
Other - Last Name:LOCHE
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:3398 E 6TH AVE APT 405
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-6640
Mailing Address - Country:US
Mailing Address - Phone:318-214-7181
Mailing Address - Fax:
Practice Address - Street 1:3838 NW 36TH ST STE 200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2916
Practice Address - Country:US
Practice Address - Phone:405-702-9032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA008911840261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)