Provider Demographics
NPI:1417950809
Name:DIMBERG, BJORN (MD)
Entity Type:Individual
Prefix:
First Name:BJORN
Middle Name:
Last Name:DIMBERG
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 1:2254 HIGHWAY A1A
Mailing Address - Street 2:
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-4922
Mailing Address - Country:US
Mailing Address - Phone:321-777-2273
Mailing Address - Fax:321-779-7425
Practice Address - Street 1:2254 HIGHWAY A1A
Practice Address - Street 2:
Practice Address - City:INDIAN HARBOUR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-4922
Practice Address - Country:US
Practice Address - Phone:321-777-2273
Practice Address - Fax:321-779-7425
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79869207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL51660OtherBCBS # FOR GROUP # 34457
FL51660OtherBCBS # FOR GROUP # 45368
FL258653300Medicaid
FL258653300Medicaid
FL51660OtherBCBS # FOR GROUP # 45368
FLE4423WMedicare PIN