Bergh, Jack Alton

Bergh, Jack Alton is an individual health care provider with primary practice located at 1539 Dale Mabry Hwy Ste 102 , Lutz FL 33548. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Bergh, Jack Alton can be contacted via phone (813) 909-7102.

Contact Information

Primary practice address
1539 Dale Mabry Hwy Ste 102 Lutz FL 33548
Phone: (813) 909-7102
Fax: (813) 909-0199
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X ME0056971 Florida

Profile Details

NPI number 1376506394
LBN Legal business name Bergh, Jack Alton
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 10th, 2006
Last updated Jan 8th, 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 1376506394 NPPES
Florida MEDICAID 770008300

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