Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | ME0058778 | FL |
N | 207NS0135X | Procedural Dermatology | ME0058778 | FL |
NPI | 1003876053 |
---|---|
Provider Name | Michael J Rogers |
First Address | Sebring, FL 33870 |
Second Address | Sebring, FL 33870 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 15/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E59551 | (02) |