Provider Demographics
NPI:1396738407
Name:BERGNER, DONALD M (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:M
Last Name:BERGNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1840 MEASE DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695
Mailing Address - Country:US
Mailing Address - Phone:727-785-6011
Mailing Address - Fax:727-787-6951
Practice Address - Street 1:1840 MEASE DRIVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695
Practice Address - Country:US
Practice Address - Phone:727-785-6011
Practice Address - Fax:727-787-6951
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2011-08-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0030517208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL065654200Medicaid
6231DMedicare ID - Type Unspecified
FL065654200Medicaid