Healthcare Provider Details

I. General information

NPI: 1144278011
Provider Name (Legal Business Name): BRADLEY BERGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 01/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SHIRCLIFF WAY
JACKSONVILLE FL
32204-4748
US

IV. Provider business mailing address

PO BOX 863026
ORLANDO FL
32886-3026
US

V. Phone/Fax

Practice location:
  • Phone: 904-308-7300
  • Fax: 904-346-0113
Mailing address:
  • Phone: 800-288-8325
  • Fax: 419-866-5453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberME0051471
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: