Provider Demographics
NPI:1205885506
Name:ROGERS, CYNTHIA JENKINS (MD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:JENKINS
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8503 S US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-3346
Mailing Address - Country:US
Mailing Address - Phone:772-398-3376
Mailing Address - Fax:772-807-8788
Practice Address - Street 1:2065 S. KANNER HIGHWAY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994
Practice Address - Country:US
Practice Address - Phone:772-398-3376
Practice Address - Fax:772-807-8788
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-06
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93551207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI38878Medicare UPIN
FL28697YMedicare PIN