MEDICARE: DR. BRUCE J ROGERS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	FLME0043684	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01409	OTHER	FL	BLUE CROSS

General Provider Information

NPI Number	:	1528056678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE J ROGERS MD

Provider Business Mailing Address
First Line	:	4739 NW 53RD AVE
Second Line	:	#A
City	:	GAINESVILLE
State	:	FL
Zip	:	32653-4800
Country	:	US
Telephone Number	:	352-371-9847
Fax Number	:	352-371-9526

Provider Business Practice Location Address
First Line	:	4739 NW 53RD AVE
Second Line	:	#A
City	:	GAINESVILLE
State	:	FL
Zip	:	32653-4800
Country	:	US
Telephone Number	:	352-371-9847
Fax Number	:	352-371-9526

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	06/25/2010

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