Organization
FLORIDA RADIOLOGY IMAGING AT LAKE MARY LLC
Active
Parent organization
FLORIDA RADIOLOGY IMAGING AT LAKE MARY
Other names
Florida Radiology Imaging at Oviedo
Organization subpart
Yes
Provider details
NPI number
Legal business name
FLORIDA RADIOLOGY IMAGING AT LAKE MARY
Authorized official
DR. JACK BERGER M.D. (MEDICAL DIRECTOR)
(407) 767-0433
Entity
Organization
Contact information
Practice address
8000 RED BUG LAKE RD, SUITE 120, OVIEDO, FL 32765-9226
(407) 767-0433
Mailing address
900 WINDERLEY PL STE 2100, MAITLAND, FL 32751-4191
(407) 767-5028
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
—
—
2085N0700X
Neuroradiology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
2085U0001X
Diagnostic Ultrasound Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
265644201
—
FL
01
—
V2787
BCBS GROUP # FOR LOCATION
FL
Enumeration date
11/03/2006
Last updated
06/20/2019
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