Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | ME104608 | FL |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | ME104608 | FL |
NPI | 1740477447 |
---|---|
Provider Name | Dr. Jeremy B Rogers |
First Address | Tampa, FL 33619-8327 |
Second Address | Brandon, FL 33511-4879 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2007 |
Last Update Date | 03/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001213100 | (05) | FL |