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1376506394
JACK ALTON BERGH
LUTZ, FL
NPI
1376506394
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
207Q00000X Family Medicine
(Licence: FL ME0056971)
Enumeration Date
2006-04-10
Last Update Date
2013-01-08
Business Address
-- JACK ALTON BERGH MD
1539 DALE MABRY HWY STE 102
LUTZ, FL 33548
Phone number: 813-909-7102
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Mailing Address
-- JACK ALTON BERGH MD
14743 MORNING DR
LUTZ, FL 33559-3257
Phone number: 813-975-4743
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