Provider Demographics
NPI:1346299179
Name:BERKEL, BOYCE N (MD)
Entity Type:Individual
Prefix:
First Name:BOYCE
Middle Name:N
Last Name:BERKEL
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 1:2330 KINGS POINT DR
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774-1009
Mailing Address - Country:US
Mailing Address - Phone:727-593-5368
Mailing Address - Fax:727-595-3181
Practice Address - Street 1:5504 GATEWAY BLVD
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-1970
Practice Address - Country:US
Practice Address - Phone:727-593-5368
Practice Address - Fax:727-595-3181
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25333208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL78275XMedicare ID - Type Unspecified
FLU58427Medicare UPIN