Organization
LARS BERGESON, MD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARS BERGESON M.D. (OWNER)
(435) 752-0330
Entity
Organization
Contact information
Practice address
382 N 280 W, PROVIDENCE, UT 84332-0609
(435) 752-0330
(435) 755-0922
Mailing address
PO BOX 609, 382 N 280 W, PROVIDENCE, UT 84332-0609
(435) 752-0330
(435) 755-0922
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
170371-1205
UT
Other
Enumeration date
09/19/2007
Last updated
02/01/2010
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