Provider Demographics
NPI:1396779021
Name:SCHWARTZBERG, ROGER KERRY (DO)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:KERRY
Last Name:SCHWARTZBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13020 PARK BLVD
Mailing Address - Street 2:OAKHURST MEDICAL CLINIC
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33776-3639
Mailing Address - Country:US
Mailing Address - Phone:727-393-3404
Mailing Address - Fax:727-393-4814
Practice Address - Street 1:13020 PARK BLVD
Practice Address - Street 2:OAKHURST MEDICAL CLINIC
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33776-3639
Practice Address - Country:US
Practice Address - Phone:727-393-3404
Practice Address - Fax:727-393-4814
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0003519207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
284244OtherAVMED
2376545OtherAETNA
2376545OtherAETNA
82166ZMedicare ID - Type Unspecified