Healthcare Provider Details

I. General information

NPI: 1699327528
Provider Name (Legal Business Name): BRYCE BERGERON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2185 CITRACADO PKWY
ESCONDIDO CA
92029-4159
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 442-281-5000
  • Fax:
Mailing address:
  • Phone: 239-343-3292
  • Fax: 239-343-3695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME156133
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA208084
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: