Provider Demographics
NPI:1730192683
Name:RODGERS, JAMES J (DO)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:RODGERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 863407
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-3407
Mailing Address - Country:US
Mailing Address - Phone:941-917-2600
Mailing Address - Fax:941-917-7884
Practice Address - Street 1:842 SUNSET LAKE BLVD
Practice Address - Street 2:SUITE 401
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-7551
Practice Address - Country:US
Practice Address - Phone:941-408-7880
Practice Address - Fax:941-408-7888
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5373207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL80478OtherBCBS
FL261637800Medicaid
FL80478WMedicare PIN
FLE87097Medicare UPIN
FL261637800Medicaid