Provider Demographics
NPI:1982894770
Name:ROGERS, JOHN W JR
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:ROGERS
Suffix:JR
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 1:349 S ROAD 1 W # C-23
Mailing Address - Street 2:
Mailing Address - City:CHINO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86323-6262
Mailing Address - Country:US
Mailing Address - Phone:928-636-0529
Mailing Address - Fax:
Practice Address - Street 1:349 S ROAD 1 W # C-23
Practice Address - Street 2:
Practice Address - City:CHINO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86323-6262
Practice Address - Country:US
Practice Address - Phone:928-636-0529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist