Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | ME97143 | FL |
Y | 2080P0208X | Pediatric Infectious Diseases | ME97143 | FL |
NPI | 1528039641 |
---|---|
Provider Name | Dale Bergamo |
First Address | Orlando, FL 32891-7770 |
Second Address | Tampa, FL 33612-4742 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2006 |
Last Update Date | 18/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
276902600 | (05) | FL |
68337 | BLUE CROSS BLUE SHIELD (01) | FL |
F01793 | (02) | FL |