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General NPI Number Information
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NPI Number | 1306856562
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Entity Type | Individual
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Provider Name | MEGAN E ROG PAC
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Gender | Female
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 12/14/2021
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Provider Practice Location Address
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Address Line | 305 BRYAN RD STE 5
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City | BRANDON
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State | FL
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Zip | 33511-5340
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Country | US
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Telephone | 813-689-2054
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Fax | 813-654-5640
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Provider Business Mailing Address
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Address Line | 305 BRYAN RD STE 5
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City | BRANDON
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State | FL
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Zip | 33511-5340
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Country | US
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Telephone | 813-689-2054
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Fax | 813-654-5640
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9101726
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License Number State | FL
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