1649677592 NPI number — ELITE CARE OF CENTRAL FLORIDA PLLC

Table of content: DR. JEROLD JAMES ROGAT D.D.S. (NPI 1528008513)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649677592 NPI number — ELITE CARE OF CENTRAL FLORIDA PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELITE CARE OF CENTRAL FLORIDA PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649677592
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
410 LIONEL WAY
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
DAVENPORT
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33837-7803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-216-5609
Provider Business Mailing Address Fax Number:
863-808-0362

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
410 LIONEL WAY
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
DAVENPORT
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33837-7803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-216-5609
Provider Business Practice Location Address Fax Number:
863-808-0362
Provider Enumeration Date:
11/20/2014

Additional Information

Authorized Official

Authorized Official Last Name:
PEREZ
Authorized Official First Name:
RUBEN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
863-875-0232

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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