Provider Demographics
NPI:1407882467
Name:ROTHENBERGER, RODGER (MD)
Entity Type:Individual
Prefix:
First Name:RODGER
Middle Name:
Last Name:ROTHENBERGER
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 1:601 S HARBOUR ISLAND BLVD STE 213
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5925
Mailing Address - Country:US
Mailing Address - Phone:727-351-0099
Mailing Address - Fax:844-388-6186
Practice Address - Street 1:7600 BRYAN DAIRY RD STE D
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777
Practice Address - Country:US
Practice Address - Phone:727-351-0099
Practice Address - Fax:844-388-6186
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME136062207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME136062OtherLICENSE NUMBER
PAE12866Medicare UPIN