Healthcare Provider Details

I. General information

NPI: 1710041629
Provider Name (Legal Business Name): JOHN H BURGER JR MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 12/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4302 ALTON RD STE 960 MSOP
MIAMI BEACH FL
33140-2891
US

IV. Provider business mailing address

4302 ALTON RD STE 960 MSOP
MIAMI BEACH FL
33140-2891
US

V. Phone/Fax

Practice location:
  • Phone: 305-531-7774
  • Fax: 305-531-8982
Mailing address:
  • Phone: 305-531-7774
  • Fax: 305-531-8982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberARNP1014042
License Number StateFL

VIII. Authorized Official

Name: MR. JAMES KEVIN GERHARDSTEIN
Title or Position: OFFICER
Credential:
Phone: 305-531-7774