Provider Demographics
NPI:1447245451
Name:ROGGOW, DEBRA K (DO)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:K
Last Name:ROGGOW
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11588 MAHOGANY RUN
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-8301
Mailing Address - Country:US
Mailing Address - Phone:239-561-7645
Mailing Address - Fax:
Practice Address - Street 1:20 BARKLEY CIR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-4545
Practice Address - Country:US
Practice Address - Phone:239-277-1772
Practice Address - Fax:239-277-1331
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6278208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF30889Medicare UPIN