Individual
DR. STEPHEN RUSSELL BERGMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
6965 CUMBERLAND GAP PKWY, HARROGATE, TN 37752-8245
(423) 869-6249
Mailing address
146 BRITTAIN DR, HARROGATE, TN 37752-7018
(720) 838-6700
Taxonomy
Speciality
Code
Description
License number
State
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
Primary
E-12201
AR
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
2007018743
MO
208D00000X
General Practice Physician
2007018743
MO
208D00000X
General Practice Physician
E-12201
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
108400081
PTAN
MO
05
—
1609021104
—
MO
Enumeration date
11/25/2008
Last updated
03/20/2023
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