# DR. STEPHEN RUSSELL BERGMAN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1609021104
- **Gender:** Man
- **Credential:** D.O.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204C00000X | Sports Medicine (Neuromusculoskeletal Medicine) Physician | E-12201 | AR | Yes |
| 204D00000X | Neuromusculoskeletal Medicine & OMM Physician | 2007018743 | MO | — |
| 208D00000X | General Practice Physician | 2007018743 | MO | — |
| 208D00000X | General Practice Physician | E-12201 | AR | — |

## Other

- **Enumeration date:** 11/25/2008
- **Last updated:** 03/20/2023