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Contact Information

JACK A BERGH, MD
1539 DALE MABRY HWY STE 102
LUTZ, FL33548
 Phone: 813-909-7102
 Fax: 813-909-0199
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family Medicine

207Q00000X 08 Physician/Family Practice
Indicates primary specialty

NPI Profile & details for JACK A BERGH · (Male)

NPI # 1376506394
Status Active
Credentials MD
Entity Individual
Enumeration date 04/10/2006
Last updated 01/08/2013 - About 13 years ago
Sole proprietor 1 No
Identifiers
  • FL License # ME0056971
  • FL Medicaid 770008300
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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