Individual
DR. JAKE BERGSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
17500 SE 392ND ST, AUBURN, WA 98092-9705
(253) 939-6648
Mailing address
PO BOX 570, OAKVILLE, WA 98568
(360) 273-5504
(360) 273-8666
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD00020595
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1043009
—
WA
05
—
1107507
—
WA
01
—
9109BE
REGENCE BLUE SHIELD
WA
Enumeration date
12/11/2006
Last updated
03/07/2023
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