Bergman, Lawrence Russell

Bergman, Lawrence Russell is an sole proprietor health care provider with primary practice located at 10115 W Forest Hill Blvd Ste 303, Wellington FL 33414-3102. He recently has only one registered license in Allopathic & Osteopathic Physicians / Adolescent Medicine, which is considered as his primary health care specialty. Bergman, Lawrence Russell can be contacted via phone (561) 798-5565.

Contact Information

Primary practice address
10115 W Forest Hill Blvd Ste 303 Wellington FL 33414-3102
Phone: (561) 798-5565
Fax: (561) 798-9756
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Adolescent Medicine 2080A0000X ME56164 Florida

Profile Details

NPI number 1073518130
LBN Legal business name Bergman, Lawrence Russell
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 16th, 2005
Last updated Sep 21st, 2011 - about 13 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 1073518130 NPPES
Florida MEDICAID 003224800

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