Provider Demographics
NPI:1902938657
Name:ROGERS, CHARLES GILBERT JR (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:GILBERT
Last Name:ROGERS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20404 MITCH RD
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-8844
Mailing Address - Country:US
Mailing Address - Phone:985-750-9288
Mailing Address - Fax:985-735-1205
Practice Address - Street 1:20404 MITCH RD
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-8844
Practice Address - Country:US
Practice Address - Phone:985-750-9288
Practice Address - Fax:985-735-1205
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019135208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1376345Medicaid
LA1376345Medicaid
LA54304Medicare ID - Type Unspecified