MEDICARE: DR. MARK ROGOVIN D.O.

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	207Q00000X	Family Medicine Physician	OS6556	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891721999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK ROGOVIN D.O.

Provider Business Mailing Address
First Line	:	7730 BOYNTON BEACH BLVD STE 3
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-6155
Country	:	US
Telephone Number	:	561-877-1800
Fax Number	:	561-742-4480

Provider Business Practice Location Address
First Line	:	7730 BOYNTON BEACH BLVD
Second Line	:	STE 3
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-6155
Country	:	US
Telephone Number	:	561-742-4460
Fax Number	:	561-742-4494

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

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	04/17/2019

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Directions to “ DR. MARK ROGOVIN D.O.” Practice Location

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