# ROGUE MEDICAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265298400
- **Authorized official:** BEN DOUGLAS JOHNSON PA-C (OWNER)
- **Authorized official phone:** (541) 778-4517

## Contact information

- **Practice address:** 205 N PHOENIX RD STE 430, PHOENIX, OR 97535-9108
- **Practice address phone:** (541) 778-4517
- **Practice address fax:** (541) 833-0995
- **Mailing address:** 205 N PHOENIX RD, PHOENIX, OR 97535-9101
- **Mailing address phone:** (541) 778-4517
- **Mailing address fax:** (541) 833-0995

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363AM0700X | Medical Physician Assistant | — | NULL | Yes |
| 363AM0700X | Medical Physician Assistant | — | — | Yes |
| 363AS0400X | Surgical Physician Assistant | — | NULL | — |
| 363AS0400X | Surgical Physician Assistant | — | — | — |

## Other

- **Enumeration date:** 02/26/2024
- **Last updated:** 02/26/2024