Organization
JAMES R BERGERON M D A MED CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES R BERGERON M.D. (PRESIDENT)
(318) 221-2623
Entity
Organization
Contact information
Practice address
2751 ALBERT L BICKNELL DR, SUITE 2-D, SHREVEPORT, LA 71103-3920
(318) 221-2623
Mailing address
2751 ALBERT BICKNELL DRIVE, SUITE 2-D, SHREVEPORT, LA 71103
(318) 221-2623
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
009227
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1440655
—
LA
Enumeration date
12/14/2006
Last updated
08/22/2020
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