Provider Demographics
NPI:1376768580
Name:ROGOZINSKI ORTHOPEDIC CLINIC, P.A.
Entity Type:Organization
Organization Name:ROGOZINSKI ORTHOPEDIC CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGOZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-733-3529
Mailing Address - Street 1:3716 UNIVERSITY BOULEVARD SOUTH
Mailing Address - Street 2:SUITE 3
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4318
Mailing Address - Country:US
Mailing Address - Phone:904-733-3529
Mailing Address - Fax:904-730-7687
Practice Address - Street 1:3716 UNIVERSITY BOULEVARD SOUTH
Practice Address - Street 2:SUITE 3
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4318
Practice Address - Country:US
Practice Address - Phone:904-733-3529
Practice Address - Fax:904-730-7687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty