Individual
MR. RUSTY BERGMAN
Active
Individual
MR. RUSTY BERGMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
05-31668
KS
207R00000X
Internal Medicine Physician
111070
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200304450A
—
KS
05
—
245007000
—
MO
01
—
33625014
BLUE SHIELD KANSAS CITY
MO
01
—
7749362
AETNA
MO
Enumeration date
07/06/2005
Last updated
10/16/2024
Update your record
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