Basic Information
Provider Information | |||||||||
NPI: | 1366585283 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | RODGERS | ||||||||
FirstName: | WILLIAM | ||||||||
MiddleName: | ROBERT | ||||||||
NamePrefix: | MR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | HS | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | USCG AIR STATION CLEARWATER | ||||||||
Address2: | 15100 RESCUE WAY | ||||||||
City: | CLEARWATER | ||||||||
State: | FL | ||||||||
PostalCode: | 33762 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7275351437 | ||||||||
FaxNumber: | 7475354190 | ||||||||
Practice Location | |||||||||
Address1: | USCG AIR STATION CLEARWATER | ||||||||
Address2: | 15100 RESCUE WAY | ||||||||
City: | CLEARWATER | ||||||||
State: | FL | ||||||||
PostalCode: | 33762 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7275351437 | ||||||||
FaxNumber: | 7475354190 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/14/2007 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247200000X |   |   | Y |   | Technologists, Technicians & Other Technical Service Providers | Technician, Other |   |
No ID Information.