Individual
JOHN ROGERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 HEALTH CENTER DR, MATTOON, IL 61938-4644
(217) 238-4325
Mailing address
PO BOX 372, MATTOON, IL 61938-0372
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01072512A
IN
207R00000X
Internal Medicine Physician
Primary
036087046
IL
208M00000X
Hospitalist Physician
036087046
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036087046
—
IL
01
—
07215036
BCBS
IL
01
—
809840
MEDICATE GROUP PTAN
IL
01
—
809840044
MEDICARE INDIVIDUAL PTAN
IL
01
—
IL0104
JOHN DEERE
IL
Enumeration date
03/14/2006
Last updated
07/24/2024
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