Provider Demographics
NPI:1144536749
Name:YERGIN PULMONARY CLINIC PA
Entity type:Organization
Organization Name:YERGIN PULMONARY CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:YERGIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-396-0300
Mailing Address - Street 1:3627 UNIVERSITY BLVD S
Mailing Address - Street 2:SUITE 300
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4230
Mailing Address - Country:US
Mailing Address - Phone:904-396-0300
Mailing Address - Fax:904-396-3039
Practice Address - Street 1:3627 UNIVERSITY BLVD S
Practice Address - Street 2:SUITE 300
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4230
Practice Address - Country:US
Practice Address - Phone:904-396-0300
Practice Address - Fax:904-396-3039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-20
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME21067207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL78027OtherBLUE CROSS BLUE SHIELD
FL215889OtherAVMED
FL0418040400Medicaid
FL1619962230OtherMEDICARE NPI
FL5362087OtherAETNA
FL406293079OtherRAILROAD MEDICARE
FL215889OtherAVMED
FL0418040400Medicaid