Provider Demographics
NPI:1295757615
Name:BERGES, EDDY E (MD)
Entity type:Individual
Prefix:DR
First Name:EDDY
Middle Name:E
Last Name:BERGES
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 1:2706 W SAINT ISABEL ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6382
Mailing Address - Country:US
Mailing Address - Phone:813-870-3665
Mailing Address - Fax:813-870-3668
Practice Address - Street 1:7001 N DALE MABRY HWY
Practice Address - Street 2:STE B
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3910
Practice Address - Country:US
Practice Address - Phone:813-870-3665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME34935174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068200400Medicaid
FL30543Medicare ID - Type Unspecified
FL068200400Medicaid