Healthcare Provider Details

I. General information

NPI: 1538110168
Provider Name (Legal Business Name): VICENTE ROGER, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1069 KANE CONCOURSE
BAY HARBOR ISLANDS FL
33154-2105
US

IV. Provider business mailing address

1069 KANE CONCOURSE
BAY HARBOR ISLANDS FL
33154-2105
US

V. Phone/Fax

Practice location:
  • Phone: 305-868-5181
  • Fax: 305-868-8292
Mailing address:
  • Phone: 305-868-5181
  • Fax: 305-868-8292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME0055378
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WENDY ROBIN GLABERSON
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 305-868-5181