Healthcare Provider Details

I. General information

NPI: 1407882467
Provider Name (Legal Business Name): RODGER ROTHENBERGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13305 N 56TH ST
TAMPA FL
33617-1161
US

IV. Provider business mailing address

PO BOX 850001, DEPT 8340
ORLANDO FL
32885-0001
US

V. Phone/Fax

Practice location:
  • Phone: 813-988-1101
  • Fax: 813-989-3899
Mailing address:
  • Phone: 813-536-7277
  • Fax: 855-830-1722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME136062
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: