Individual
DR. NICKLES PAUL BERGERON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
800 E MAIN ST, VILLE PLATTE, LA 70586-4618
(225) 766-7796
Mailing address
200 CORPORATE BLVD, SUITE 201, LAFAYETTE, LA 70508-3870
(800) 893-9698
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
199948
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1057665
—
LA
Enumeration date
06/02/2006
Last updated
07/08/2007
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