| Doctor Name: | MR. THOMAS J BERGERON |
| NPI Number: | 1407016298 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 39080 Rosaryville Rd Ponchatoula, LA - 704547000 |
| Business Phone Number: | 9859743231 |
| Business Fax Number: | 2252946217 |
| Mailing Address: | 39080 Rosaryville Rd, PONCHATOULA |
| State: | LA |
| Postal Code: | 704547000 |
| Phone Number: | 9859743231 |
| Fax Number: | 2252945170 |
| NPI Enumeration Date: | 06/15/2008 |
| NPI Last Update Date: | 06/15/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171WH0202X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Contractor |
| Taxonomy Specialization: | Home Modifications |
| Taxonomy Definition: | |