MEDICARE: RODERICK C BURROUGHS

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
1	172A00000X	Driver		FL

General Provider Information

NPI Number	:	1831868850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RODERICK C BURROUGHS

Provider Business Mailing Address
First Line	:	2739 VIA CAPRI UNIT 1021
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33764-3996
Country	:	US
Telephone Number	:	251-533-7993
Fax Number	:

Provider Business Practice Location Address
First Line	:	2739 VIA CAPRI UNIT 1021
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33764-3996
Country	:	US
Telephone Number	:	251-533-7993
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2021
Last Update Date	:	09/13/2021

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Directions to “ RODERICK C BURROUGHS ” Practice Location

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