Individual
DR. JON A. BERGERON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.H.D.
Contact information
Practice address
16741 WOODLAKE DR, COLLEGE STATION, TX 77845-8273
(979) 575-5198
Mailing address
16741 WOODLAKE DR, COLLEGE STATION, TX 77845-8273
(979) 575-5198
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
31998
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1596470-01
—
TX
01
—
86790A
BLUE SHIELD
TX
01
—
P00028151
RR/MEDICARE
TX
Enumeration date
03/23/2006
Last updated
11/25/2013
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