Individual
MR. RUSTY BERGMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
5675 ROE BLVD, ROELAND PARK, KS 66205-2515
(913) 432-2080
Mailing address
5675 ROE BLVD, ROELAND PARK, KS 66205-2515
(913) 432-2080
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
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