Individual
DR. PAUL J BERGGREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1300 N 12TH ST, #613, PHOENIX, AZ 85006-2848
(602) 254-5321
(602) 254-6582
Mailing address
3020 E CAMELBACK RD, SUITE 301, PHOENIX, AZ 85016-5059
(602) 264-9100
(602) 264-9101
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
21349
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
120390
GROUP MEDICARE NUMBER
AZ
05
—
131508
—
AZ
05
—
131508-03
—
AZ
01
—
317047
GROUP MEDICAID NUMBER
AZ
Enumeration date
10/07/2005
Last updated
02/16/2017
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