Provider Demographics
NPI:1972547354
Name:RODGERS, ROBERT MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MICHAEL
Last Name:RODGERS
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 1:755 RINEHART RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-4886
Mailing Address - Country:US
Mailing Address - Phone:407-320-8100
Mailing Address - Fax:407-320-8110
Practice Address - Street 1:755 RINEHART RD STE 200
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-4886
Practice Address - Country:US
Practice Address - Phone:407-320-8100
Practice Address - Fax:407-320-8110
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME60939207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080164514OtherRAILROAD MEDICARE
FL267171900Medicaid
FL14782OtherBCBS
FL14782WMedicare PIN
FL267171900Medicaid