Doctor Name: | DR. BERT EUGENE BERGLAND |
NPI Number: | 1407111768 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.O. |
License Number: | DOS-1349 |
Business Practice Address: | 405 Ponderosa Ave Estes Park, CO - 80517 |
Business Phone Number: | 7194392700 |
Business Fax Number: | |
Mailing Address: | 405 Ponderosa Ave, ESTES PARK |
State: | CO |
Postal Code: | 805177022 |
Phone Number: | 7194392700 |
Fax Number: | |
NPI Enumeration Date: | 07/11/2012 |
NPI Last Update Date: | 08/31/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 207QA0505X |
License Number: | DOS-1349 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | HI |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Family Medicine |
Taxonomy Specialization: | Adult Medicine |
Taxonomy Definition: |