Healthcare Provider Details

I. General information

NPI: 1487618443
Provider Name (Legal Business Name): PAUL STEPHEN BERGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 12/21/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 BAY CLIFFS RD
GULF BREEZE FL
32561-4809
US

IV. Provider business mailing address

815 BAY CLIFFS RD
GULF BREEZE FL
32561-4809
US

V. Phone/Fax

Practice location:
  • Phone: 850-207-1555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME55221
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: