Individual
EDMOND X BERGERON III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.P.
Contact information
Practice address
806 JEFFERSON TER, NEW IBERIA, LA 70560-5727
(337) 365-4945
Mailing address
806 JEFFERSON TER, NEW IBERIA, LA 70560-5727
(337) 365-4945
(337) 376-6860
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
606MP
LA
103TP0016X
Prescribing (Medical) Psychologist
Primary
606MP
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1660841
—
LA
Enumeration date
10/20/2006
Last updated
10/22/2019
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