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Organization
ROGUE MEDICAL LLC
Active
Organization
ROGUE MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BEN DOUGLAS JOHNSON PA-C (OWNER)
(541) 778-4517
Entity
Organization
Contact information
Practice address
205 N PHOENIX RD STE 430, PHOENIX, OR 97535-9108
(541) 778-4517
(541) 833-0995
Mailing address
205 N PHOENIX RD, PHOENIX, OR 97535-9101
(541) 778-4517
(541) 833-0995
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
NULL
363AM0700X
Medical Physician Assistant
Primary
—
—
363AS0400X
Surgical Physician Assistant
—
NULL
363AS0400X
Surgical Physician Assistant
—
—
Other
Enumeration date
02/26/2024
Last updated
02/26/2024
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