MEDICARE: ROGERS AND DAVIDSON PA

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	207Q00000X	Family Medicine Physician	FLME0056564	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	21604A	OTHER	FL	BLUE CROSS GROUP NUMBER

General Provider Information

NPI Number	:	1689664401
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROGERS AND DAVIDSON PA

Provider Business Mailing Address
First Line	:	4707 NW 53RD AVE
Second Line	:	SUITE B
City	:	GAINESVILLE
State	:	FL
Zip	:	32653-4805
Country	:	US
Telephone Number	:	352-337-9900
Fax Number	:	352-374-9259

Provider Business Practice Location Address
First Line	:	4707 NW 53RD AVE
Second Line	:	SUITE B
City	:	GAINESVILLE
State	:	FL
Zip	:	32653-4805
Country	:	US
Telephone Number	:	352-337-9900
Fax Number	:	352-374-9259

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	KIM M DAVIDSON
Credential	:	MD
Telephone Number	:	352-337-9900

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	07/01/2010

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Directions to “ROGERS AND DAVIDSON PA ” Practice Location

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