Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | CH5159 | FL |
NPI | 1326067661 |
---|---|
Provider Name | Dr. Richard E. Rogovin |
First Address | Brandon, FL 33511-5316 |
Second Address | Brandon, FL 33511-5316 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 05/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
22111 | (02) | FL |