Provider Demographics
NPI:1629173273
Name:BERGER, PATRICK JOHN (DO)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:JOHN
Last Name:BERGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3059 EDGEWOOD AVE W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-2207
Mailing Address - Country:US
Mailing Address - Phone:904-647-3180
Mailing Address - Fax:904-425-9030
Practice Address - Street 1:3059 EDGEWOOD AVE W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-2207
Practice Address - Country:US
Practice Address - Phone:904-647-3180
Practice Address - Fax:904-425-9030
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9169207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G81688Medicare UPIN