MEDICARE: J BERGERON MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1083809339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J BERGERON MD PA

Provider Business Mailing Address
First Line	:	1961 W TC JESTER BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-1256
Country	:	US
Telephone Number	:	713-225-9355
Fax Number	:	713-861-8970

Provider Business Practice Location Address
First Line	:	1961 W TC JESTER BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-1256
Country	:	US
Telephone Number	:	713-225-9355
Fax Number	:	713-861-8970

Authorized Official
Title or Position	:	MEDICAL DIRECTOR/OWNER
Name	:	JOHN BERGERON
Credential	:	MD
Telephone Number	:	713-225-9355

Provider Enumeration Date	:	09/10/2007
Last Update Date	:	09/10/2007

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