Provider Demographics
NPI:1275885188
Name:GORFINKEL, ROGER (PA-C)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:GORFINKEL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13685 DOCTORS WAY
Mailing Address - Street 2:SUITE 170
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4336
Mailing Address - Country:US
Mailing Address - Phone:239-440-6456
Mailing Address - Fax:239-204-2054
Practice Address - Street 1:13685 DOCTORS WAY
Practice Address - Street 2:SUITE 170
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4336
Practice Address - Country:US
Practice Address - Phone:239-440-6456
Practice Address - Fax:239-204-2054
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2016-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106771363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant