Provider Demographics
NPI:1649576653
Name:ROGERS, DIANA EVELYN (DPM, MS)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:EVELYN
Last Name:ROGERS
Suffix:
Gender:F
Credentials:DPM, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6420 W NEWBERRY RD STE 210
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-6621
Mailing Address - Country:US
Mailing Address - Phone:352-525-2779
Mailing Address - Fax:352-525-2794
Practice Address - Street 1:6420 W NEWBERRY RD STE 210
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-6621
Practice Address - Country:US
Practice Address - Phone:352-525-2779
Practice Address - Fax:352-525-2794
Is Sole Proprietor?:No
Enumeration Date:2011-02-09
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3418213ES0103X
IL16.005862213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1649576653Medicaid
WIK400417175OtherMEDICARE (UHS PHYSICIAN CLINIC)