MEDICARE: DR. ROGER KERRY SCHWARTZBERG 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	OS0003519	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	284244	OTHER		AVMED
2	2376545	OTHER		AETNA

General Provider Information

NPI Number	:	1396779021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGER KERRY SCHWARTZBERG D.O.

Provider Business Mailing Address
First Line	:	13020 PARK BLVD
Second Line	:	OAKHURST MEDICAL CLINIC
City	:	SEMINOLE
State	:	FL
Zip	:	33776-3639
Country	:	US
Telephone Number	:	727-393-3404
Fax Number	:	727-393-4814

Provider Business Practice Location Address
First Line	:	13020 PARK BLVD
Second Line	:	OAKHURST MEDICAL CLINIC
City	:	SEMINOLE
State	:	FL
Zip	:	33776-3639
Country	:	US
Telephone Number	:	727-393-3404
Fax Number	:	727-393-4814

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	12/21/2011

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