MEDICARE: EVAN BERGMANN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	OS16192	FL

General Provider Information

NPI Number	:	1336594548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVAN BERGMANN D.O.

Provider Business Mailing Address
First Line	:	7593 W BOYNTON BEACH BLVD STE 220
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-6162
Country	:	US
Telephone Number	:	561-678-2652
Fax Number	:

Provider Business Practice Location Address
First Line	:	15300 S JOG RD STE 205
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33446-2166
Country	:	US
Telephone Number	:	561-496-7200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2016
Last Update Date	:	11/20/2023

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