Individual
MRS. MARY F. BERGUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3154 E 29TH AVE, SPOKANE, WA 99223-4852
(509) 448-4870
(888) 286-8401
Mailing address
3154 E 29TH AVE, SPOKANE, WA 99223-4852
(509) 448-4870
(888) 286-8401
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00042807
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G8865268
PTAN
WA
Enumeration date
11/24/2006
Last updated
03/19/2020
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