Provider Demographics
NPI:1073604518
Name:ROG, JOHN A (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:ROG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:239-599-2612
Practice Address - Street 1:2237 LITHIA CENTER LN
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-5676
Practice Address - Country:US
Practice Address - Phone:813-662-0123
Practice Address - Fax:813-662-9422
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2020-08-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0074753207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLKY258OtherMEDICARE
FL42910OtherBCBS