Individual
STACY JOHN BERCKES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
111 WATERMAN AVE, MOUNT DORA, FL 32757-9541
(352) 735-3313
(352) 735-3711
Mailing address
111 WATERMAN AVE, MOUNT DORA, FL 32757-9541
(352) 735-3313
(352) 735-3711
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
ME0043723
FL
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
ME0043723
FL
208VP0000X
Pain Medicine Physician
ME0043723
FL
208VP0014X
Interventional Pain Medicine Physician
ME0043723
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050031800
RAILROAD MEDICARE
FL
05
—
069131300
—
FL
Enumeration date
01/18/2006
Last updated
12/30/2013
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