Provider Demographics
NPI:1063115517
Name:ROGERS, WESTON DOUGLAS
Entity type:Individual
Prefix:
First Name:WESTON
Middle Name:DOUGLAS
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 1:15735 HICKORY LN
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-9233
Mailing Address - Country:US
Mailing Address - Phone:479-790-7857
Mailing Address - Fax:
Practice Address - Street 1:3201 SPRINGHILL DR STE 100
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2905
Practice Address - Country:US
Practice Address - Phone:501-955-4530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program