Provider Demographics
NPI:1295833812
Name:BERGEN, GARY (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:BERGEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 GOODLETTE RD N
Mailing Address - Street 2:SUITE 370
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5400
Mailing Address - Country:US
Mailing Address - Phone:239-624-0800
Mailing Address - Fax:239-643-9062
Practice Address - Street 1:800 GOODLETTE RD N
Practice Address - Street 2:SUITE 370
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5400
Practice Address - Country:US
Practice Address - Phone:239-624-0800
Practice Address - Fax:239-643-9062
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58044207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL23564VOtherMEDICARE
FL273217300Medicaid
FL23564OtherBCBS
FL273217300Medicaid
FL23564VOtherMEDICARE