Provider Demographics
NPI:1467445221
Name:RODGER, SCOTT A (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:A
Last Name:RODGER
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:PO BOX 1887
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32727-1887
Mailing Address - Country:US
Mailing Address - Phone:352-483-1466
Mailing Address - Fax:352-483-1134
Practice Address - Street 1:2200 S BAY ST
Practice Address - Street 2:SUITE A
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-6314
Practice Address - Country:US
Practice Address - Phone:352-483-1466
Practice Address - Fax:352-483-1134
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2009-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0053992207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E30551Medicare UPIN
07709Medicare ID - Type Unspecified