Healthcare Provider Details

I. General information

NPI: 1760105043
Provider Name (Legal Business Name): STEVE BERGMAN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6003 E BASELINE RD
MESA AZ
85206-4815
US

IV. Provider business mailing address

PO BOX 7096
STOCKTON CA
95267-0096
US

V. Phone/Fax

Practice location:
  • Phone: 480-641-6500
  • Fax:
Mailing address:
  • Phone: 209-956-7732
  • Fax: 209-956-7738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVEN BERGMAN
Title or Position: OWNER
Credential: DO
Phone: 480-215-6170