MEDICARE: JORDAN ROGERS M.D.

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	207P00000X	Emergency Medicine Physician	D0083557	MD
2	207P00000X	Emergency Medicine Physician	MD045420	DC
3	207P00000X	Emergency Medicine Physician	TRN17252	FL

General Provider Information

NPI Number	:	1568721710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN ROGERS M.D.

Provider Business Mailing Address
First Line	:	3780 NW 24TH BLVD
Second Line	:	APARTMENT #208
City	:	GAINESVILLE
State	:	FL
Zip	:	32605-5662
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 SW ARCHER RD
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32608-1134
Country	:	US
Telephone Number	:	352-275-0111
Fax Number	:

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

Provider Enumeration Date	:	05/09/2012
Last Update Date	:	10/05/2021

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