Healthcare Provider Details

I. General information

NPI: 1063402071
Provider Name (Legal Business Name): ROGERS AND DAVIDSON PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 07/02/2010
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: 352-371-9526
Mailing address:
  • Phone: 352-371-9847
  • Fax: 352-371-9526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberFLME0043684
License Number StateFL

VIII. Authorized Official

Name: BRUCE J. ROGERS
Title or Position: PRESIDENT
Credential: MD
Phone: 352-371-9847