Basic Information
| Provider Information | |||||||||
| NPI: | 1093240061 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERLIOZ | ||||||||
| FirstName: | BERIC | ||||||||
| MiddleName: | EMILIO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7207 GOLDEN WINGS RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322443324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043891010 | ||||||||
| FaxNumber: | 9043891082 | ||||||||
| Practice Location | |||||||||
| Address1: | 7207 GOLDEN WINGS RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322443324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043891010 | ||||||||
| FaxNumber: | 9043891082 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2017 | ||||||||
| LastUpdateDate: | 10/14/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | ME141877 | FL | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 208VP0014X | ME141877 | FL | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 207L00000X | ME141877 | FL | N | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 115268100 | 05 | FL | MEDICAID |