Basic Information
| Provider Information | |||||||||
| NPI: | 1265492946 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROGERS | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | ALLEN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1845 RIDGEWOOD CIR | ||||||||
| Address2: | |||||||||
| City: | SALINE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481768838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349445320 | ||||||||
| FaxNumber: | 7347128209 | ||||||||
| Practice Location | |||||||||
| Address1: | 5325 ELLIOTT DR | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | YPSILANTI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481978633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347125500 | ||||||||
| FaxNumber: | 7347128209 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 5601002002 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.