Individual
DR. JAMES R BERGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
15800 95TH AVE N, MAPLE GROVE, MN 55369-4400
(952) 993-1440
Mailing address
3800 PARK NICOLLET BLVD, CREDENTIALING, ST LOUIS PARK, MN 55416-2527
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
22332
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
929788000
—
MN
Enumeration date
12/28/2005
Last updated
02/29/2012
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