Provider Demographics
NPI:1083712558
Name:BERG, ROBERT ERIC (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ERIC
Last Name:BERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3357 SW VILLA PLACE
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990
Mailing Address - Country:US
Mailing Address - Phone:772-283-4014
Mailing Address - Fax:
Practice Address - Street 1:528 SE OSCEOLA ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994
Practice Address - Country:US
Practice Address - Phone:772-287-3020
Practice Address - Fax:772-282-9562
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71748207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
636818Medicare UPIN
32283Medicare ID - Type Unspecified