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General NPI Number Information
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NPI Number | 1164653929
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Entity Type | Individual
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Provider Name | JEFFERY JOSEPH BERGMAN D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/28/2009
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Last Update Date | 01/08/2026
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Provider Practice Location Address
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Address Line | 1350 HICKORY ST
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City | MELBOURNE
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State | FL
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Zip | 32901-3224
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Country | US
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Telephone | 321-434-7208
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Fax | 321-434-5344
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Provider Business Mailing Address
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Address Line | 4690 RUMMELL RD BERGMAN MEDICAL LLC
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City | SAINT CLOUD
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State | FL
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Zip | 34771-9696
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Country | US
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Telephone | 407-680-4182
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 4739
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | OS11615
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 103328
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | P0550
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License Number State | TX
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