Healthcare Provider Details

I. General information

NPI: 1902752454
Provider Name (Legal Business Name): MONTANAH L ROGERS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 DIXIE BLVD STE 103
DELRAY BEACH FL
33444-3857
US

IV. Provider business mailing address

1050 AUDACE AVE APT 5-404
BOYNTON BEACH FL
33426-3351
US

V. Phone/Fax

Practice location:
  • Phone: 561-278-3245
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9121677
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: