Provider Demographics
NPI:1336237031
Name:BERGER, JONATHAN BARRY (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:BARRY
Last Name:BERGER
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 1:880 NW 13TH ST
Mailing Address - Street 2:SUITE 3 A
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2342
Mailing Address - Country:US
Mailing Address - Phone:561-361-8106
Mailing Address - Fax:561-361-1010
Practice Address - Street 1:880 NW 13TH ST
Practice Address - Street 2:SUITE 3 A
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2342
Practice Address - Country:US
Practice Address - Phone:561-361-8106
Practice Address - Fax:561-361-1010
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69601207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG53661Medicare UPIN
FL32844AMedicare ID - Type Unspecified