Individual
DR. BRIAN SCOTT BERGSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO, MA
Contact information
Practice address
101 S MOORE AVE, CLAREMORE, OK 74017-5047
(918) 342-6200
Mailing address
13006 E 112TH ST N, OWASSO, OK 74055-6220
(913) 674-7320
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
5942
OK
Other
Enumeration date
02/21/2015
Last updated
07/30/2020
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