Jack Alton Bergh, MD | |
1539 Dale Mabry Hwy Ste 102, Lutz, FL 33548 | |
(813) 909-7102 | |
(813) 909-0199 |
Full Name | Jack Alton Bergh |
---|---|
Gender | Male |
Speciality | Family Medicine |
Location | 1539 Dale Mabry Hwy Ste 102, Lutz, Florida |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1376506394 | NPI | - | NPPES |
770008300 | Medicaid | FL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | ME0056971 (Florida) | Primary |
Entity Name | Wellmed Medical Management Of Florida Inc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1033395397 PECOS PAC ID: 3971678558 Enrollment ID: O20080815000432 |
Mailing Address | Practice Location Address |
---|---|
Jack Alton Bergh, MD 14743 Morning Dr, Lutz, FL 33559-3257 Ph: (813) 975-4743 | Jack Alton Bergh, MD 1539 Dale Mabry Hwy Ste 102, Lutz, FL 33548 Ph: (813) 909-7102 |
Dr. Myra C Gibson, MD Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 4123 Highland Park Cir, Lutz, FL 33558 Phone: 813-482-5291 | |
Dr. Eric Joseph Crall, M.D. Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 4953 Van Dyke Rd, Lutz, FL 33558 Phone: 813-321-1783 Fax: 877-992-2302 | |
Dr. Ronald Eugene Stephans Jr., MD Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 4211 Van Dyke Rd, Suite B, Lutz, FL 33558 Phone: 813-960-4026 Fax: 813-960-4489 | |
Andres Santayana, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 17724 Hunting Bow Cir Ste 101, Lutz, FL 33558 Phone: 813-723-5456 Fax: 813-723-5457 | |
Dr. Tad Robert Connine, MD Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 23546 State Road 54, Lutz, FL 33559 Phone: 813-990-7443 Fax: 813-864-7443 | |
Dr. Erika M. Agnew, D.O. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 4211 Van Dyke Rd Ste 101b, Lutz, FL 33558 Phone: 813-960-4026 Fax: 813-443-8166 |