Provider Demographics
NPI:1558896340
Name:ROGOZINSKI, ZACHARY SHAI (MD)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:SHAI
Last Name:ROGOZINSKI
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 1:3716 UNIVERSITY BLVD S STE 3
Mailing Address - Street 2:
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:
Practice Address - Street 1:3716 UNIVERSITY BLVD S STE 3
Practice Address - Street 2:
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:
Is Sole Proprietor?:No
Enumeration Date:2017-04-29
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC87489207XX0005X
FL159800207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC874897Medicaid