Bergen, Brent D
Bergen, Brent D is an individual health care provider with primary practice located at 3800 S National Ave Ste 510 , Springfield MO 65807-5284. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pulmonary Disease, which is considered as his primary health care specialty. Bergen, Brent D can be contacted via phone (417) 875-3160.Contact Information
Primary practice address
3800 S National Ave Ste 510
Springfield MO 65807-5284
Phone: (417) 875-3160
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pulmonary Disease | 207RP1001X | 2007001545 | Missouri |
Profile Details
| NPI number | 1629070693 |
|---|---|
| LBN Legal business name | Bergen, Brent D |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 10th, 2005 |
| Last updated | Dec 27th, 2018 - about 7 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1629070693 | NPPES |
| Missouri | MEDICAID | 204593909 | |
| Missouri | Other | 1069441 | |
| Missouri | Other | 000000048062 | |
| Missouri | Other | 290009315 | |
| Missouri | MEDICAID | 200096100A | |
| Missouri | MEDICAID | 64319783 |
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