=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336318377
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRYON L. BERGE, D.O., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2008
-----------------------------------------------------
Last Update Date | 02/25/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9101 HARLAN ST 306
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80031-2924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-425-5700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1780 WASHINGTON ST #303
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80203-1490
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | BRYON L BERGE
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 303-859-5755
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 41510
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------