Individual
DR. ROGER KEROACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
SHCC, 1 FLETCHER DRIVE, GAINESVILLE, FL 32611-7500
(352) 392-1171
Mailing address
2222 NW 20TH ST, GAINESVILLE, FL 32605-3986
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PY2755
FL
Other
Enumeration date
05/23/2006
Last updated
07/08/2007
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