Basic Information
| Provider Information | |||||||||
| NPI: | 1396779021 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHWARTZBERG | ||||||||
| FirstName: | ROGER | ||||||||
| MiddleName: | KERRY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13020 PARK BLVD | ||||||||
| Address2: | OAKHURST MEDICAL CLINIC | ||||||||
| City: | SEMINOLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337763639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273933404 | ||||||||
| FaxNumber: | 7273934814 | ||||||||
| Practice Location | |||||||||
| Address1: | 13020 PARK BLVD | ||||||||
| Address2: | OAKHURST MEDICAL CLINIC | ||||||||
| City: | SEMINOLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337763639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273933404 | ||||||||
| FaxNumber: | 7273934814 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 12/21/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | OS0003519 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 284244 | 01 | AVMED | OTHER | 2376545 | 01 | AETNA | OTHER |