Provider Demographics
NPI:1700832607
Name:ROGERS, WILLIAM DEWITT JR (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DEWITT
Last Name:ROGERS
Suffix:JR
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 1:149 EDINBURGH DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4102
Mailing Address - Country:US
Mailing Address - Phone:407-644-1675
Mailing Address - Fax:407-644-3483
Practice Address - Street 1:149 EDINBURGH DR
Practice Address - Street 2:SUITE A
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-4102
Practice Address - Country:US
Practice Address - Phone:407-644-1675
Practice Address - Fax:407-644-3483
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME18428207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL48959OtherBCBS
P00115560OtherRAILROAD MEDICARE
FL069333200Medicaid
FL48959YMedicare PIN
D64251Medicare UPIN