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NPI Code Detail

MEDICARE: MR. DOUGLAS WAYNE ROGERS

MEDICARE: MR. DOUGLAS WAYNE ROGERS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner872AK

General Provider Information

NPI Number : 1770553133
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DOUGLAS WAYNE ROGERS
Provider Business Mailing Address
First Line : 9093 ASHVILLE DR
Second Line :
City : PENSACOLA
State : FL
Zip : 32514-5695
Country : US
Telephone Number : 850-776-5549
Fax Number :
Provider Business Practice Location Address
First Line : 790 VETERANS WAY
Second Line :
City : PENSACOLA
State : FL
Zip : 32507-1000
Country : US
Telephone Number : 850-912-2131
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2006
Last Update Date : 02/05/2013

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