Individual
DR. JAKE BERGSTROM
Active
Individual
DR. JAKE BERGSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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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