Berckes, Stacy John

Berckes, Stacy John is an individual health care provider with primary practice located at 111 Waterman Ave , Mount Dora FL 32757-9541. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Anesthesiology, Allopathic & Osteopathic Physicians / Pain Medicine, Allopathic & Osteopathic Physicians / Interventional Pain Medicine. Allopathic & Osteopathic Physicians / Pain Medicine is his primary health care specialty. Berckes, Stacy John can be contacted via phone (352) 735-3313.

Contact Information

Primary practice address
111 Waterman Ave Mount Dora FL 32757-9541
Phone: (352) 735-3313
Fax: (352) 735-3711
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Anesthesiology 207L00000X ME0043723 Florida
Allopathic & Osteopathic Physicians / Pain Medicine 207LP2900X ME0043723 Florida
Allopathic & Osteopathic Physicians / Pain Medicine 208VP0000X ME0043723 Florida
Allopathic & Osteopathic Physicians / Interventional Pain Medicine 208VP0014X ME0043723 Florida

Profile Details

NPI number 1750361523
LBN Legal business name Berckes, Stacy John
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 18th, 2006
Last updated Dec 30th, 2013 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1750361523 NPPES
Florida MEDICAID 069131300
Florida Other 050031800

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