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General NPI Number Information
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NPI Number | 1306965371
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Entity Type | Individual
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Provider Name | ROGER BURT BERGMAN PA
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Gender | Male
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7000 SW 62ND AVE SUITE 545
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-4716
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Country | US
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Telephone | 305-669-6166
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 QUAYSIDE TER APT 1904
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City | MIAMI SHORES
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State | FL
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Zip | 33138-2243
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Country | US
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Telephone | 305-895-6659
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9100770
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License Number State | FL
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