Healthcare Provider Details

I. General information

NPI: 1366585283
Provider Name (Legal Business Name): WILLIAM ROBERT RODGERS HS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USCG AIR STATION CLEARWATER 15100 RESCUE WAY
CLEARWATER FL
33762
US

IV. Provider business mailing address

USCG AIR STATION CLEARWATER 15100 RESCUE WAY
CLEARWATER FL
33762
US

V. Phone/Fax

Practice location:
  • Phone: 727-535-1437
  • Fax: 747-535-4190
Mailing address:
  • Phone: 727-535-1437
  • Fax: 747-535-4190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: