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General NPI Number Information
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NPI Number | 1083809339
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Entity Type | Organization
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Legal Business Name | J BERGERON MD PA
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Dates
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Enumeration Date | 09/10/2007
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Last Update Date | 09/10/2007
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Provider Practice Location Address
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Address Line | 1961 W TC JESTER BLVD
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City | HOUSTON
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State | TX
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Zip | 77008-1256
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Country | US
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Telephone | 713-225-9355
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Fax | 713-861-8970
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Provider Business Mailing Address
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Address Line | 1961 W TC JESTER BLVD
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City | HOUSTON
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State | TX
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Zip | 77008-1256
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Country | US
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Telephone | 713-225-9355
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Fax | 713-861-8970
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Authorized Official
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Title or Position | MEDICAL DIRECTOR/OWNER
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Name | JOHN BERGERON
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Credential | MD
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Telephone | 713-225-9355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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