Individual
RYAN BERGESON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1520 LEANDER RD STE 101, GEORGETOWN, TX 78628-8842
(512) 942-2499
(512) 943-0001
Mailing address
1520 LEANDER RD STE 100, GEORGETOWN, TX 78628-8829
(512) 942-2499
(512) 943-0001
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
2003-0222
NM
207XS0117X
Orthopaedic Surgery of the Spine Physician
41610
KY
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
N2403
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000577128
ANTHEM (SPINE INSTITUTE)
KY
01
—
000000586305
ANTHEM (UNIV ORTHO ASSOC)
KY
05
—
219591906
—
TX
Enumeration date
02/06/2007
Last updated
06/23/2020
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