Individual
GORDIE ROGERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4035 GRANDE VISTA BLVD APT 105, SAINT AUGUSTINE, FL 32084-1303
(904) 501-4754
Mailing address
4035 GRANDE VISTA BLVD APT 105, SAINT AUGUSTINE, FL 32084-1303
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
01/12/2019
Last updated
01/12/2019
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