Provider Demographics
NPI:1871556290
Name:BERGER, JAY S (MD)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:S
Last Name:BERGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1713 HIGHWAY 441 N
Mailing Address - Street 2:SUITE D
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972-1900
Mailing Address - Country:US
Mailing Address - Phone:863-467-1117
Mailing Address - Fax:863-467-2775
Practice Address - Street 1:1713 HIGHWAY 441 N
Practice Address - Street 2:SUITE D
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-1900
Practice Address - Country:US
Practice Address - Phone:863-467-1117
Practice Address - Fax:863-467-2775
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46844207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL044218600Medicaid
FLD62491Medicare UPIN
FL47049ZMedicare PIN