Individual
EGERTON K VAN DEN BERG JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2320 N ORANGE AVE, ORLANDO, FL 32804-5506
(407) 896-0054
(407) 898-4463
Mailing address
2320 N ORANGE AVE, ORLANDO, FL 32804-5506
(407) 896-0054
(407) 898-4463
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
117611
TX
207RC0000X
Cardiovascular Disease Physician
Primary
ME54054
FL
207RI0011X
Interventional Cardiology Physician
117611
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103555800
—
FL
Enumeration date
09/12/2006
Last updated
09/12/2019
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