Healthcare Provider Details

I. General information

NPI: 1285656611
Provider Name (Legal Business Name): HOWARD ROGERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 01/26/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 SW 1ST AVE
OCALA FL
34471-6504
US

IV. Provider business mailing address

1500 SW 1ST AVE
OCALA FL
34471-6504
US

V. Phone/Fax

Practice location:
  • Phone: 407-975-0412
  • Fax: 407-975-0413
Mailing address:
  • Phone: 407-975-0412
  • Fax: 407-975-0413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME71304
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: