Healthcare Provider Details

I. General information

NPI: 1477664480
Provider Name (Legal Business Name): GARY S ROGERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 SE 3RD CT STE A
OCALA FL
34471-0484
US

IV. Provider business mailing address

900 VILLAGE SQUARE XING STE 290
PALM BEACH GARDENS FL
33410-4552
US

V. Phone/Fax

Practice location:
  • Phone: 352-732-0339
  • Fax: 352-732-3725
Mailing address:
  • Phone: 239-313-2517
  • Fax: 239-313-2555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number58289
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME176828
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number58289
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: