Provider Demographics
NPI:1962910026
Name:ROGERS, JOSHUA JAMES (PA-C)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:JAMES
Last Name:ROGERS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2908 MALL RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-1641
Mailing Address - Country:US
Mailing Address - Phone:256-767-2702
Mailing Address - Fax:256-718-6047
Practice Address - Street 1:2908 MALL RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-1641
Practice Address - Country:US
Practice Address - Phone:256-767-2702
Practice Address - Fax:256-718-6047
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2149363AM0700X
ALPA.1524363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALPA.1524OtherMEDICAL LICENSE