Healthcare Provider Details

I. General information

NPI: 1548796196
Provider Name (Legal Business Name): JORDAN BERGMANN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2017
Last Update Date: 08/23/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL MEDICAL CTR 34800 BOB WILSON DR
SAN DIEGO CA
92134-0001
US

IV. Provider business mailing address

4494 PALMER RD N
BETHESDA MD
20814-0001
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-6827
  • Fax: 619-532-7508
Mailing address:
  • Phone: 301-295-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number37335
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: