MEDICARE: BRANDON BERGERON 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	390200000X	Student in an Organized Health Care Education/Training Program
2	207R00000X	Internal Medicine Physician	48283	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000	OTHER		NONMEDICARE

General Provider Information

NPI Number	:	1497486625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON BERGERON MD

Provider Business Mailing Address
First Line	:	188 HOSPITAL DR STE 402
Second Line	:
City	:	FAIRHOPE
State	:	AL
Zip	:	36532-2018
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2115 HAND AVE STE B
Second Line	:
City	:	BAY MINETTE
State	:	AL
Zip	:	36507-4149
Country	:	US
Telephone Number	:	251-937-7100
Fax Number	:	251-937-9882

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

Provider Enumeration Date	:	06/20/2022
Last Update Date	:	08/06/2025

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Directions to “ BRANDON BERGERON MD” Practice Location

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