Individual
MR. CHARLES LEWIS ROGERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OPA-C
Contact information
Practice address
1111 TRINITY LN, SUITE 111, BLOOMINGTON, IL 61704-8111
(309) 663-6461
(309) 663-5711
Mailing address
1111 TRINITY LN, SUITE 111, BLOOMINGTON, IL 61704-8111
(309) 663-6461
(309) 663-5711
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
238.000269
IL
Other
Enumeration date
03/29/2007
Last updated
01/09/2017
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