Organization
RANDALL P BERGEN DPM PC
Active
Organization
RANDALL P BERGEN DPM PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDALL PAUL BERGEN DPM (PRESIDENT PHYSICIAN)
(712) 255-3526
Entity
Organization
Contact information
Practice address
505 5TH ST, SUITE 714, SIOUX CITY, IA 51101-1500
(712) 255-3526
(712) 255-0298
Mailing address
505 5TH ST, SUITE 714, SIOUX CITY, IA 51101-1500
(712) 255-3526
(712) 255-0298
Taxonomy
Speciality
Code
Description
License number
State
261QP1100X
Podiatric Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0091108
—
IA
01
—
09110
WELLMARK BCBS
IA
01
—
480007118
RAILROAD MEDICARE
IA
Enumeration date
05/16/2008
Last updated
05/16/2008
Update your record
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