Healthcare Provider Details

I. General information

NPI: 1194037523
Provider Name (Legal Business Name): ROGERS AND DAVIDSON, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2010
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4739 NW 53RD AVE SUITE A
GAINESVILLE FL
32653-4800
US

IV. Provider business mailing address

4739 NW 53RD AVE SUITE A
GAINESVILLE FL
32653-4800
US

V. Phone/Fax

Practice location:
  • Phone: 352-371-9847
  • Fax:
Mailing address:
  • Phone: 352-371-9847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME56564
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME43684
License Number StateFL

VIII. Authorized Official

Name: KIM DAVIDSON
Title or Position: VICE-PRESIDENT
Credential: M.D.
Phone: 352-337-9900