Organization
LARS BERGESON, M.D., PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARS BERGESON M.D. (OWNER)
(435) 752-0330
Entity
Organization
Contact information
Practice address
382 W 280 N, PROVIDENCE, UT 84332-0609
(435) 752-0330
(435) 755-0922
Mailing address
PO BOX 609, 382 W 280 N, PROVIDENCE, UT 84332-0609
(435) 752-0330
(435) 755-0922
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
157381244047
—
UT
Enumeration date
12/08/2009
Last updated
12/08/2009
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