Healthcare Provider Details

I. General information

NPI: 1225121973
Provider Name (Legal Business Name): CARL E. BERGSAGEL MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 S. COLUMBIAN WAY
SEATTLE WA
98108
US

IV. Provider business mailing address

15111 12TH DR SE
MILL CREEK WA
98012
US

V. Phone/Fax

Practice location:
  • Phone: 206-768-5333
  • Fax: 206-768-5331
Mailing address:
  • Phone: 206-768-5333
  • Fax: 206-768-5331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0205X
TaxonomyRadiological Physics Physician
License NumberN/A
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: