Provider Demographics
NPI:1972500338
Name:BERK, JAMES W (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:W
Last Name:BERK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4500 W NEWBERRY RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-2245
Mailing Address - Country:US
Mailing Address - Phone:352-336-6000
Mailing Address - Fax:352-332-0799
Practice Address - Street 1:14417 NW 152ND LN
Practice Address - Street 2:
Practice Address - City:ALACHUA
Practice Address - State:FL
Practice Address - Zip Code:32615-8667
Practice Address - Country:US
Practice Address - Phone:386-462-6400
Practice Address - Fax:386-462-6404
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2015-02-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME70764207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL31955XMedicare PIN
FLG33812Medicare UPIN