Provider Demographics
NPI:1699834358
Name:MADORE, ROGER J (PA CC)
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:J
Last Name:MADORE
Suffix:
Gender:M
Credentials:PA CC
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Mailing Address - Street 1:1020 LAKE SUMTER LANDING
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162
Mailing Address - Country:US
Mailing Address - Phone:352-674-1700
Mailing Address - Fax:352-674-8919
Practice Address - Street 1:1400 US HWY 441 N
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162
Practice Address - Country:US
Practice Address - Phone:352-674-8700
Practice Address - Fax:352-674-8714
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2017-04-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA2133363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAM642XMedicare UPIN