Individual
DEREK BERGERON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D
Contact information
Practice address
1650 COCHRANE CIR, EVANS ARMY COMMUNITY HOSPITAL, FORT CARSON, CO 80913
(719) 503-7920
Mailing address
1650 COCHRANE CIR, EVANS ARMY COMMUNITY HOSPITAL, FORT CARSON, CO 80913
(719) 524-3508
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY.0004175
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2865917
—
TX
Enumeration date
07/19/2011
Last updated
02/21/2024
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