Healthcare Provider Details

I. General information

NPI: 1164487062
Provider Name (Legal Business Name): LAUREN CLAIRE BERKOW M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 09/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD BOX 100371
GAINESVILLE FL
32610-0371
US

IV. Provider business mailing address

1600 SW ARCHER RD BOX 100371
GAINESVILLE FL
32610-0371
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-6575
  • Fax:
Mailing address:
  • Phone: 352-273-6575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD54873
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberD54873
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberD54873
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME129039
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: