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Individual
RANDALL JAMES ROGERS
Active
Individual
RANDALL JAMES ROGERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C, LMT
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
MA58093
FL
363A00000X
Physician Assistant
Primary
PA9102164
FL
363AM0700X
Medical Physician Assistant
PA 9102164
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA58093
STATE OF FLORIDA LICENSE
FL
01
—
PA 9102164
STATE OF FLORIDA LICENSE
FL
Enumeration date
02/28/2007
Last updated
11/16/2018
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