Provider Demographics
NPI:1033500749
Name:EDDY E. BERGES, M.D.
Entity Type:Organization
Organization Name:EDDY E. BERGES, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-870-3665
Mailing Address - Street 1:2706 W. ST. ISABEL ST.
Mailing Address - Street 2:SUITE A
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6320
Mailing Address - Country:US
Mailing Address - Phone:813-870-3665
Mailing Address - Fax:813-870-3668
Practice Address - Street 1:2706 W SAINT ISABEL ST
Practice Address - Street 2:SUITE A
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6382
Practice Address - Country:US
Practice Address - Phone:813-870-3665
Practice Address - Fax:813-870-3668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-17
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068200400Medicaid
FLD54030Medicare UPIN