Individual
MR. GLEN M. ROGERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
550 17TH AVE FL 5, SEATTLE, WA 98122-5788
(206) 320-2800
(206) 320-2827
Mailing address
PO BOX 25608, SALT LAKE CITY, UT 84125-0608
(206) 320-4476
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA60299909
WA
363AS0400X
Surgical Physician Assistant
Primary
PA60299909
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2023881
—
WA
Enumeration date
03/09/2006
Last updated
01/12/2026
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