Individual
JACKSON RODGERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
1000 N LEE AVE, OKLAHOMA CITY, OK 73102-1036
(405) 272-7000
Mailing address
5A WHISPERING PINES CT, MACON, IL 62544-7218
(636) 866-8958
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4644
OK
363A00000X
Physician Assistant
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/26/2020
Last updated
06/09/2022
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