Dr. Lawrence Russell Bergman
Adolescent Medicine
10115 W Forest Hill Blvd Ste 303
Wellington
, Florida 33414-3102
Dr. Lawrence Russell Bergman
Adolescent Medicine
10115 W Forest Hill Blvd Ste 303
Wellington
, Florida 33414-3102
(561) 798-9756
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About
Features
Specialties
- Adolescent Medicine
Languages spoken
- English
Location
First Address
- Dr. Lawrence Russell Bergman
- 10115 W Forest Hill Blvd Ste 303
- Wellington, FL
- Zip : 33414-3102
- Fax : (561) 798-9756
- Phone : (561) 798-5565
Second Address
- Dr. Lawrence Russell Bergman
- 10115 W Forest Hill Blvd Ste 303
- Wellington, FL
- Zip : 33414-3102
- Fax : (561) 798-9756
- Phone : (561) 798-5565
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 2080A0000X | Adolescent Medicine | ME56164 | FL |
National Provider Identifier
| NPI | 1073518130 |
|---|---|
| Provider Name | Dr. Lawrence Russell Bergman |
| First Address | Wellington, FL 33414-3102 |
| Second Address | Wellington, FL 33414-3102 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 16/06/2005 |
| Last Update Date | 21/09/2011 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 003224800 | (05) | FL |
| E91787 | (02) | FL |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.