Provider Demographics
NPI:1003876053
Name:ROGERS, MICHAEL J
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:ROGERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 US 27 SOUTH
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870
Mailing Address - Country:US
Mailing Address - Phone:863-385-7183
Mailing Address - Fax:863-385-0088
Practice Address - Street 1:727 US 27 SOUTH
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870
Practice Address - Country:US
Practice Address - Phone:863-385-7183
Practice Address - Fax:863-385-0088
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0058778207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7022Medicare PIN
E59551Medicare UPIN