Individual
JACK WILLIAM BERGMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3931 LOUISIANA AVE S, ST LOUIS PARK, MN 55426-5000
(952) 993-3230
(952) 993-1748
Mailing address
3931 LOUISIANA AVE S, ST LOUIS PARK, MN 55426-5000
(952) 993-3230
(952) 993-1748
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
13280
MN
Other
Enumeration date
08/15/2018
Last updated
01/17/2020
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