Basic Information
| Provider Information | |||||||||
| NPI: | 1114346988 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROGERS | ||||||||
| FirstName: | SHERISE | ||||||||
| MiddleName: | CHANTELL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 100278 | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326100001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314447411 | ||||||||
| FaxNumber: | 6314442493 | ||||||||
| Practice Location | |||||||||
| Address1: | DIVISION OF HEMATOLOGY/ONCOLOGY 2000 SW ARCHER ROAD | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326100001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522657955 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2014 | ||||||||
| LastUpdateDate: | 07/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RX0202X | 35.130976 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | 207RH0000X | ME145966 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology |
ID Information
| ID | Type | State | Issuer | Description | 107261400 | 05 | FL | MEDICAID |