Individual
DIANE K BERGAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
701 W COCOA BEACH CSWY, COCOA BEACH, FL 32931-3585
(321) 799-7111
(770) 237-4866
Mailing address
PO BOX 2400, MELBOURNE, FL 32902-2400
(866) 744-1461
(770) 621-3181
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
ME747701
FL
2085N0904X
Nuclear Radiology Physician
ME747701
FL
2085P0229X
Pediatric Radiology Physician
ME747701
FL
2085R0202X
Diagnostic Radiology Physician
Primary
ME747701
FL
2085R0204X
Vascular & Interventional Radiology Physician
ME747701
FL
2085U0001X
Diagnostic Ultrasound Physician
ME747701
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
062324500
—
FL
01
—
10851
BCBS
FL
01
—
10851U
MEDICARE PTAN
FL
01
—
30048846
MEDICARE RR
—
Enumeration date
08/04/2006
Last updated
08/05/2013
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