Individual
DR. LAWRENCE RUSSELL BERGMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10115 W FOREST HILL BLVD, STE 303, WELLINGTON, FL 33414-3102
(561) 798-5565
(561) 798-9756
Mailing address
10115 W FOREST HILL BLVD, STE 303, WELLINGTON, FL 33414-3102
(561) 798-5565
(561) 798-9756
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
ME56164
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003224800
—
FL
Enumeration date
06/16/2005
Last updated
09/21/2011
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