Provider Demographics
NPI:1033176078
Name:ROGG, RUSSELL PAUL (AP OMD)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:PAUL
Last Name:ROGG
Suffix:
Gender:M
Credentials:AP OMD
Other - Prefix:
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Mailing Address - Street 1:20433 OLD CUTLER RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33189-1833
Mailing Address - Country:US
Mailing Address - Phone:305-251-4325
Mailing Address - Fax:305-256-7850
Practice Address - Street 1:20433 OLD CUTLER RD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33189-1833
Practice Address - Country:US
Practice Address - Phone:305-251-4325
Practice Address - Fax:305-256-7850
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL000283171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist