Provider Demographics
NPI:1962781617
Name:ROGERS, TIMOTHY C (RPA)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:C
Last Name:ROGERS
Suffix:
Gender:M
Credentials:RPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23425 HIGHWAY 1084
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70435-6652
Mailing Address - Country:US
Mailing Address - Phone:985-893-2006
Mailing Address - Fax:
Practice Address - Street 1:23425 HIGHWAY 1084
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70435-6652
Practice Address - Country:US
Practice Address - Phone:985-893-2006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY10 LA 1402243U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant