| Doctor Name: | DR. LAWRENCE RUSSELL BERGMAN |
| NPI Number: | 1073518130 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | ME56164 |
| Business Practice Address: | 10115 W Forest Hill Blvd Ste 303 Wellington, FL - 334143102 |
| Business Phone Number: | 5617985565 |
| Business Fax Number: | 5617989756 |
| Mailing Address: | 10115 W Forest Hill Blvd, Ste 303 WELLINGTON |
| State: | FL |
| Postal Code: | 334143102 |
| Phone Number: | 5617985565 |
| Fax Number: | 5617989756 |
| NPI Enumeration Date: | 06/16/2005 |
| NPI Last Update Date: | 09/21/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2080A0000X |
| License Number: | ME56164 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Pediatrics |
| Taxonomy Specialization: | Adolescent Medicine |
| Taxonomy Definition: | A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. |