Provider Demographics
NPI:1619962230
Name:YERGIN, BRUCE MITCHELL (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:MITCHELL
Last Name:YERGIN
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 1:8773 PERIMETER PARK CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1165
Mailing Address - Country:US
Mailing Address - Phone:904-493-3390
Mailing Address - Fax:904-493-3395
Practice Address - Street 1:3627 UNIVERSITY BLVD S STE 300
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216
Practice Address - Country:US
Practice Address - Phone:904-396-0300
Practice Address - Fax:904-396-3039
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0021067207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5362087OtherAETNA
FLGR172AOtherMEDICARE - GROUP
FL78027OtherBLUE CROSS BLUE SHIELD
FL0098365-00OtherFL MEDICAID - GROUP
FL0141594-00Medicaid
FLPO1615058OtherRR MEDICARE
FL215889OtherAVMED
FLPO1615058OtherRR MEDICARE
FL0141594-00Medicaid