Individual
LANCE K BERGSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2601 UNIVERSITY DR S, FARGO, ND 58103-6025
(701) 235-5200
(701) 237-0927
Mailing address
2601 UNIVERSITY DR S, FARGO, ND 58103-6025
(701) 235-5200
(701) 237-0927
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
38105
MN
174400000X
Specialist
Primary
7230
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01068001
BCBS OF ND
ND
05
—
080024400
—
MN
05
—
12698
—
ND
05
—
18672
—
ND
01
—
236454
ND BCBS
ND
01
—
33A70BE
MN BCBS
MN
01
—
33A71BE
MN BCBS
MN
Enumeration date
06/22/2006
Last updated
08/09/2010
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