Healthcare Provider Details

I. General information

NPI: 1649576653
Provider Name (Legal Business Name): DIANA EVELYN ROGERS DPM, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2011
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 W NEWBERRY RD STE 210
GAINESVILLE FL
32605-6621
US

IV. Provider business mailing address

6420 W NEWBERRY RD STE 210
GAINESVILLE FL
32605-6621
US

V. Phone/Fax

Practice location:
  • Phone: 352-525-2779
  • Fax: 352-525-2794
Mailing address:
  • Phone: 352-525-2779
  • Fax: 352-525-2794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO3418
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: