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General NPI Number Information
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NPI Number | 1154460152
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Entity Type | Individual
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Provider Name | RYAN BERGESON MD
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Gender | Male
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 06/23/2020
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Provider Practice Location Address
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Address Line | 1520 LEANDER RD STE 101
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City | GEORGETOWN
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State | TX
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Zip | 78628-8842
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Country | US
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Telephone | 512-942-2499
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Fax | 512-943-0001
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Provider Business Mailing Address
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Address Line | 1520 LEANDER RD STE 100
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City | GEORGETOWN
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State | TX
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Zip | 78628-8829
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Country | US
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Telephone | 512-942-2499
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Fax | 512-943-0001
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 2003-0222
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | 41610
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | N2403
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License Number State | TX
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