Provider Demographics
NPI:1609617497
Name:AUSTIN, ROGERS (MBAC)
Entity type:Individual
Prefix:
First Name:ROGERS
Middle Name:
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:MBAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4851 E 185TH ST S
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-5634
Mailing Address - Country:US
Mailing Address - Phone:918-894-2918
Mailing Address - Fax:
Practice Address - Street 1:4851 E 185TH ST S
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-5634
Practice Address - Country:US
Practice Address - Phone:918-894-2918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4137560347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle