Provider Demographics
NPI:1528056678
Name:ROGERS, BRUCE J (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:J
Last Name:ROGERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4739 NW 53RD AVE
Mailing Address - Street 2:#A
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-4800
Mailing Address - Country:US
Mailing Address - Phone:352-371-9847
Mailing Address - Fax:352-371-9526
Practice Address - Street 1:4739 NW 53RD AVE
Practice Address - Street 2:#A
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653-4800
Practice Address - Country:US
Practice Address - Phone:352-371-9847
Practice Address - Fax:352-371-9526
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2010-06-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLFLME0043684207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL01409OtherBLUE CROSS
FL01409AMedicare ID - Type Unspecified
FLD82293Medicare UPIN