MEDICARE: MR. DAVID ERIC BOGERT M.S., M.B.A.

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	101YM0800X	Mental Health Counselor	MH3008	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	593468490	OTHER		AETNA

General Provider Information

NPI Number	:	1518923366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID ERIC BOGERT M.S., M.B.A.

Provider Business Mailing Address
First Line	:	323 LAKESHORE BLVD
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34769-2451
Country	:	US
Telephone Number	:	321-284-1840
Fax Number	:	321-284-1854

Provider Business Practice Location Address
First Line	:	3389 W VINE ST
Second Line	:	SUITE 304
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-4665
Country	:	US
Telephone Number	:	321-284-1840
Fax Number	:	321-284-1854

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

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	06/09/2009

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Directions to “ MR. DAVID ERIC BOGERT M.S., M.B.A.” Practice Location

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