Individual
MR. ROGER M FOGG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
8600 NEW HOPE RD, GRANTS PASS, OR 97527-8978
(541) 862-2836
(541) 862-2806
Mailing address
8600 NEW HOPE RD, GRANTS PASS, OR 97527-8978
(541) 862-2836
(541) 862-2806
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
200350113NP FNP-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
298515
—
OR
Enumeration date
09/15/2006
Last updated
07/02/2013
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