Provider Demographics
NPI:1164653929
Name:BERGMAN, JEFFERY JOSEPH (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:JOSEPH
Last Name:BERGMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4690 RUMMELL RD
Mailing Address - Street 2:BERGMAN MEDICAL LLC
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771-9696
Mailing Address - Country:US
Mailing Address - Phone:407-680-4182
Mailing Address - Fax:
Practice Address - Street 1:1350 HICKORY ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3224
Practice Address - Country:US
Practice Address - Phone:321-434-7208
Practice Address - Fax:321-434-5344
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS11615208000000X
OK4739208000000X
TXP0550208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics