Individual
RYAN WILLARD ROGERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1029 NICHOLS RD STE 201, OSAGE BEACH, MO 65065-3008
(573) 302-7138
Mailing address
54 HOSPITAL DR, OSAGE BEACH, MO 65065-3050
(573) 348-8000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2011003943
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
220026034
—
MO
Enumeration date
02/14/2011
Last updated
04/29/2025
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