Basic Information
| Provider Information | |||||||||
| NPI: | 1457310054 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERGER | ||||||||
| FirstName: | MAURY | ||||||||
| MiddleName: | BRUCE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3130 SW 32ND AVE | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344744445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527324032 | ||||||||
| FaxNumber: | 3527324191 | ||||||||
| Practice Location | |||||||||
| Address1: | 3130 SW 32ND AVE | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344744445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527324032 | ||||||||
| FaxNumber: | 3527324191 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2006 | ||||||||
| LastUpdateDate: | 03/26/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | ME80629 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 830008227 | 01 | FL | RAILROAD MEDICARE | OTHER | 259323800 | 05 | FL | MEDICAID |