Provider Demographics
NPI:1720088024
Name:ROGERS, EDWIN WILLIAM JR (MD)
Entity Type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:WILLIAM
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 1:825 BAYSHORE DRIVE
Mailing Address - Street 2:UNIT 1300
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507-3470
Mailing Address - Country:US
Mailing Address - Phone:850-572-1160
Mailing Address - Fax:850-434-1880
Practice Address - Street 1:COMMUNITY HEALTH NORTHWEST FLORIDA
Practice Address - Street 2:2315 W. JACKSON ST
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32505
Practice Address - Country:US
Practice Address - Phone:850-436-4630
Practice Address - Fax:850-857-1747
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2022-02-09
Deactivation Date:2019-05-29
Deactivation Code:
Reactivation Date:2022-02-08
Provider Licenses
StateLicense IDTaxonomies
FLME38487207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0658065 00Medicaid
AL009304110Medicaid
FL0658065 00Medicaid
AL009304110Medicaid