Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Myrtle Ridge Family Medicine, PA

Organization Family Medicine Physician · NPI 1427195809

Myrtle Ridge Family Medicine, PA is a Family Medicine Physician in Lutz, Florida. Licensed in Florida. Registered with an NPI since 2007.

Licensed in
FL
In the registry since
2007
What do these letters mean?
PA — Professional association
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1539 Dale Mabry Hwy 102
Lutz, FL 33548-3008
Phone: (813) 909-7102
Fax: (813) 909-0199
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence ME0056971 (FL)

Record details

NPI number1427195809
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jack Bergh — Ceo · (813) 909-7102
NPI enumeratedFebruary 1, 2007
Last updated in NPPESJanuary 10, 2013
Mailing addressPo Box 660, Lutz, FL 33548-0660

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