Provider Demographics
NPI:1073551255
Name:CAIN, ROGERS (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGERS
Middle Name:
Last Name:CAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9390 LEM TURNER RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32208-2200
Mailing Address - Country:US
Mailing Address - Phone:904-766-2992
Mailing Address - Fax:904-766-2993
Practice Address - Street 1:9390 LEM TURNER RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-2200
Practice Address - Country:US
Practice Address - Phone:904-766-2992
Practice Address - Fax:904-766-2993
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL49968207Q00000X
GA047407207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL049256600Medicaid
FL049256600Medicaid
FL08159ZMedicare PIN