Healthcare Provider Details

I. General information

NPI: 1457329468
Provider Name (Legal Business Name): BERJAN COLLIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 10/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 SE HILLMOOR DR STE C 207
PORT ST LUCIE FL
34952-7553
US

IV. Provider business mailing address

356 E MIDWAY RD
FORT PIERCE FL
34982-7148
US

V. Phone/Fax

Practice location:
  • Phone: 772-335-4234
  • Fax: 772-335-4236
Mailing address:
  • Phone: 772-464-9746
  • Fax: 772-464-9750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME 74857
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: