Individual
JASON B BERGMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
19550 E 39TH ST S STE 335, INDEPENDENCE, MO 64057-2311
(816) 350-0005
(816) 350-0015
Mailing address
19550 E 39TH ST S STE 335, INDEPENDENCE, MO 64057-2311
(816) 350-0005
(816) 350-0015
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2004016407
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200418930A
—
KS
05
—
201468105
—
MO
01
—
P00373752
RAILROAD
MO
Enumeration date
08/03/2006
Last updated
05/18/2022
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