Individual
LEE J BERGMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1708 YAKIMA AVE, STE 105, TACOMA, WA 98405-5307
(253) 426-4420
(253) 426-4383
Mailing address
1708 YAKIMA AVE, STE 105, TACOMA, WA 98405-5307
(253) 426-4420
(253) 426-4383
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10001194
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0187933
STATE L&I
WA
01
—
0190122
STATE L&I
WA
01
—
0194827
STATE L&I
WA
05
—
8332330
—
WA
01
—
8939078
STATE CRIME VICTIMS
WA
Enumeration date
08/05/2006
Last updated
11/10/2010
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