Individual
GREGORY ALAN BERGMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4463 STATE ROUTE 66N, MINSTER, OH 45865-8727
(419) 394-3387
(419) 628-9501
Mailing address
1002 S KNOXVILLE AVE, GRAND LAKE PHYSICIAN PRACTICES, SAINT MARYS, OH 45885-2607
(419) 394-3387
(419) 628-9501
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
047703
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0537502
—
OH
01
—
1104024546
ORGANIZATIONAL NPI
OH
01
—
2268237
MEDICAID LEGACY
OH
01
—
9934723
MEDICARE PTAN
OH
Enumeration date
06/16/2005
Last updated
02/03/2011
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