Individual
DR. LARS BERGESON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
382 W 280 N, PROVIDENCE, UT 84332-9707
(435) 752-0330
(435) 755-0922
Mailing address
PO BOX 609, PROVIDENCE, UT 84332-0609
(435) 752-0330
(435) 755-0922
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
170371-1205
UT
Other
Enumeration date
02/23/2006
Last updated
11/09/2009
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