Healthcare Provider Details

I. General information

NPI: 1134136583
Provider Name (Legal Business Name): ROBERT MATTHEW BERGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 SUNCOAST BLVD C/O SEVEN RIVERS REGIONAL
CRYSTAL RIVER FL
34428
US

IV. Provider business mailing address

PO BOX 457
CRYSTAL RIVER FL
34423
US

V. Phone/Fax

Practice location:
  • Phone: 352-795-4008
  • Fax: 352-795-9041
Mailing address:
  • Phone: 352-795-4008
  • Fax: 352-795-9041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME0035313
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: