Basic Information
| Provider Information | |||||||||
| NPI: | 1164487062 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERKOW | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | CLAIRE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 SW ARCHER RD | ||||||||
| Address2: | BOX 100371 | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326100371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522736575 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1600 SW ARCHER RD | ||||||||
| Address2: | BOX 100371 | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326100371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522736575 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2006 | ||||||||
| LastUpdateDate: | 09/29/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | D54873 | MD | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LC0200X | D54873 | MD | N | Allopathic & Osteopathic Physicians | Anesthesiology | Critical Care Medicine | 207LP2900X | D54873 | MD | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207L00000X | ME129039 | FL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 203002100 | 05 | MD | MEDICAID | 018347000 | 05 | FL | MEDICAID |