Provider Demographics
NPI:1679560536
Name:GARRETT, RODGER KENNETH (MD)
Entity Type:Individual
Prefix:
First Name:RODGER
Middle Name:KENNETH
Last Name:GARRETT
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 1:4901 GRANDE DR STE B
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-5936
Mailing Address - Country:US
Mailing Address - Phone:855-527-7246
Mailing Address - Fax:833-810-1165
Practice Address - Street 1:4901 MARKET PLACE RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8986
Practice Address - Country:US
Practice Address - Phone:855-527-7246
Practice Address - Fax:833-810-1165
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2023-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78069207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257491800Medicaid
FL46797OtherBCBS FL
FL46797OtherBCBS FL
FL257491800Medicaid