Healthcare Provider Details

I. General information

NPI: 1215497953
Provider Name (Legal Business Name): LUKE S ROGERS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 HOSPITAL DR STE 230
PALM COAST FL
32164-2458
US

IV. Provider business mailing address

3300 S FISKE BLVD
ROCKLEDGE FL
32955-4306
US

V. Phone/Fax

Practice location:
  • Phone: 386-586-4455
  • Fax:
Mailing address:
  • Phone: 321-361-5565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberOS21691
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: