Healthcare Provider Details

I. General information

NPI: 1467445221
Provider Name (Legal Business Name): SCOTT A RODGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 11/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 S BAY ST SUITE A
EUSTIS FL
32726-6314
US

IV. Provider business mailing address

PO BOX 1887
EUSTIS FL
32727-1887
US

V. Phone/Fax

Practice location:
  • Phone: 352-483-1466
  • Fax: 352-483-1134
Mailing address:
  • Phone: 352-483-1466
  • Fax: 352-483-1134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME0053992
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: