Individual
TYLER BERGSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2820 MOUNT RUSHMORE RD, RAPID CITY, SD 57701-5462
(605) 342-3280
Mailing address
PO BOX 6020, RAPID CITY, SD 57709-6020
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
9906
SD
Other
Enumeration date
03/21/2011
Last updated
06/30/2016
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