Individual
DR. CARMEN RENEE BERGOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1255 GRAHAM RD, DEPT RADIATION ONCOLOGY, FLORISSANT, MO 63031-8014
(314) 820-6751
(314) 820-6752
Mailing address
PO BOX 7412011, CHICAGO, IL 60674-2011
(314) 820-6751
(314) 820-6752
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
2020031317
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200089105
—
MO
Enumeration date
07/13/2008
Last updated
04/15/2025
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