MEDICARE: ANTHONY BEAUMONT VAN BERGEYK MD

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	207X00000X	Orthopaedic Surgery Physician	601484763	WA
2	207XX0004X	Orthopaedic Foot and Ankle Surgery Physician	MD00044729	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316987803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY BEAUMONT VAN BERGEYK MD

Provider Business Mailing Address
First Line	:	3801 5TH ST SE STE 110
Second Line	:
City	:	PUYALLUP
State	:	WA
Zip	:	98374-2106
Country	:	US
Telephone Number	:	253-845-9585
Fax Number	:	253-848-1126

Provider Business Practice Location Address
First Line	:	3801 5TH ST SE STE 110
Second Line	:
City	:	PUYALLUP
State	:	WA
Zip	:	98374-2106
Country	:	US
Telephone Number	:	253-845-9585
Fax Number	:	253-848-1126

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	10/16/2023

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