Healthcare Provider Details

I. General information

NPI: 1114933488
Provider Name (Legal Business Name): STEVEN E RODGERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 02/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE BOX 016960 (M851)
MIAMI FL
33136-1005
US

IV. Provider business mailing address

1611 NW 12TH AVE BOX 016960 (M851)
MIAMI FL
33136-1005
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-1288
  • Fax:
Mailing address:
  • Phone: 305-585-1288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME96364
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: