Basic Information
| Provider Information | |||||||||
| NPI: | 1912906330 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROGERS | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | MITCHELL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1822 E HOLLADAY FARM LN | ||||||||
| Address2: | |||||||||
| City: | HOLLADAY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841175773 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012322420 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4403 HARRISON BLVD STE 4640 | ||||||||
| Address2: | |||||||||
| City: | OGDEN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 844033304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013874850 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2005 | ||||||||
| LastUpdateDate: | 03/29/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | 162015-1205 | UT | Y | Allopathic & Osteopathic Physicians | Allergy & Immunology |
No ID Information.