Provider Demographics
NPI:1689664401
Name:ROGERS AND DAVIDSON PA
Entity Type:Organization
Organization Name:ROGERS AND DAVIDSON PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-337-9900
Mailing Address - Street 1:4707 NW 53RD AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-4805
Mailing Address - Country:US
Mailing Address - Phone:352-337-9900
Mailing Address - Fax:352-374-9259
Practice Address - Street 1:4707 NW 53RD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653-4805
Practice Address - Country:US
Practice Address - Phone:352-337-9900
Practice Address - Fax:352-374-9259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-24
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLME0056564207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21604AOtherBLUE CROSS GROUP NUMBER
FL21604AMedicare PIN