Roman Rogozin, PA
Physician Assistant in Fort Campbell, KY. Individual provider (NPI-1).
NPI number1073361069
StatusActive
Last updated in NPPESDec 15, 2025
Details
- NPI
- 1073361069
- Entity type
- Individual (NPI-1)
- Name
- Roman Rogozin
- Credential
- PA
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- May 7, 2024
- Certification date
- Dec 15, 2025
- Last updated
- Dec 15, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 1236757 | TN | Yes |
Practice location
650 Joel DrFort Campbell, KY 42223-5318
Phone 270-798-8400
Mailing address
879 Terraceside CirClarksville, TN 37040-6175
Phone 726-400-1012
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