JACK ALTON BERGH (NPI# 1376506394) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376506394 |
| Entity Type | Individual |
| Full Name | JACK ALTON BERGH |
| Credential | MD |
| Practice Address |
1539 Dale Mabry Hwy Ste 102 Lutz FL 33548 |
| Mailing Address |
14743 Morning Dr Lutz FL 33559-3257 |
| Practice Telephone | 8139097102 |
| Practice Fax Number | 8139090199 |
| Mailing Telephone | 8139754743 |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2013-01-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | ME0056971 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 770008300 | 05 |
| Street Address |
1539 DALE MABRY HWY STE 102 |
| City | LUTZ |
| State | FL |
| Zip Code | 33548 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619504354 | Myrtle Ridge Primary Care, P.a | Nurse Practitioner | 1539 Dale Mabry Hwy Ste 102, Lutz, FL 33548-3008 | 2020-03-24 |
| 1376170225 | Myrtle Ridge Healthcare Center, LLC | Nurse Practitioner | 1539 Dale Mabry Hwy Ste 102, Lutz, FL 33548-3008 | 2020-03-23 |
| 1639733207 | Roberto Luis Cruz Garcia | General Practice | 1539 Dale Mabry Hwy Ste 102, Lutz, FL 33548-3008 | 2019-04-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205337821 | Chiros On 54 LLC | Chiropractor | 1003 N Dale Mabry Hwy, Lutz, FL 33548 | 2018-02-28 |
| 1295233666 | Issac M Arroyo | Behavior Technician | 18288 Us 41, Lutz, FL 33548 | 2018-01-31 |
| 1699293225 | Lettuce Lake Emergency Physicians LLC | Physician Assistant | 1430 Dale Mabry Highway, Lutz, FL 33548 | 2017-09-04 |
| 1780010512 | Yanina Abaunza-fiallos Md Pa | Pediatrics | 17541 N. Dale Mabry Hwy., Lutz, FL 33548 | 2013-09-25 |
| 1891138459 | Atlas Medical Services, Inc | Durable Medical Equipment & Medical Supplies | 3859 Van Dyke Rd, Suite 161, Lutz, FL 33548 | 2013-04-14 |
| 1407122492 | Tania Isabel Mendoza | Pathology | 19045 N Dale Mabry Hwy, Lutz, FL 33548 | 2012-03-24 |
| 1528362944 | Life Discovery Counseling Center | Counselor | 18371 Exciting Idlewild Blvd, Lutz, FL 33548 | 2010-12-28 |
| 1356643423 | Heidi Jane Pickering | Chiropractor | 19011 N Dale Mabry, Lutz, FL 33548 | 2010-11-23 |
| 1992015762 | Yolanda R. Harper | Social Worker | 1527 Dale Mabry Hwy Ste 103, Lutz, FL 33548 | 2010-10-14 |
| 1821231846 | Michael Lee Bishop | Psychologist | 18958 N Dale Mabry Hwy, Ste 102, Lutz, FL 33548 | 2009-04-07 |
| Find all providers in zip 33548 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811514029 | Jenna Langford | Family Medicine | 1634 Audubon Trl, Lutz, FL 33549-9508 | 2020-07-03 |
| 1942712690 | Larry Joseph Luter | Family Medicine | 19741 Prince Benjamin Dr, Lutz, FL 33549-5018 | 2017-11-02 |
| 1033507348 | Myra C Gibson | Family Medicine | 4123 Highland Park Cir, Lutz, FL 33558-5314 | 2015-01-08 |
| 1629484373 | Rucha Kharwa Patel | Family Medicine | 18981 N Dale Mabry Hwy, Lutz, FL 33548-4981 | 2014-07-02 |
| 1427297241 | Living Wellness, LLC | Family Medicine | 19105 N Us Highway 41 Ste 200, Lutz, FL 33549-4206 | 2009-02-18 |
| 1427195809 | Myrtle Ridge Family Medicine, Pa | Family Medicine | 1539 Dale Mabry Hwy, 102, Lutz, FL 33548-3008 | 2007-02-01 |
| 1255375689 | Elisa J. Thompson | Family Medicine | 18923 State Road 54, Lutz, FL 33558-5268 | 2006-06-15 |
| 1114979952 | Eric Joseph Crall | Family Medicine | 4651 Van Dyke Rd, Lutz, FL 33558 | 2006-05-17 |
| 1740248384 | James A Sotrop | Family Medicine | 19021 N Dale Mabry Hwy, Lutz, FL 33548-4982 | 2006-05-03 |
| 1083672125 | Stephen Paul Meyer | Family Medicine | 18956 N Dale Mabry Hwy, Suite 102, Lutz, FL 33548-4915 | 2006-05-01 |
| Find all providers in LUTZ | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.