Provider Demographics
NPI:1144237660
Name:ROGERS, MARC J (DO)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:J
Last Name:ROGERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4500 W NEWBERRY RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-2245
Mailing Address - Country:US
Mailing Address - Phone:352-336-6000
Mailing Address - Fax:352-332-0799
Practice Address - Street 1:1710 SE 16TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-4656
Practice Address - Country:US
Practice Address - Phone:352-620-1900
Practice Address - Fax:352-620-1901
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS9469207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275755900Medicaid
FLU5323WMedicare PIN
I36543Medicare UPIN