Provider Demographics
NPI:1063402071
Name:ROGERS AND DAVIDSON PA
Entity type:Organization
Organization Name:ROGERS AND DAVIDSON PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-371-9847
Mailing Address - Street 1:4739 NW 53RD AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-4800
Mailing Address - Country:US
Mailing Address - Phone:352-371-9847
Mailing Address - Fax:352-371-9526
Practice Address - Street 1:4739 NW 53RD AVE
Practice Address - Street 2:SUITE A
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653-4800
Practice Address - Country:US
Practice Address - Phone:352-371-9847
Practice Address - Fax:352-371-9526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-21
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLME0043684207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21604OtherGROUP BC NUMBER
FL21604OtherGROUP BC NUMBER